![Kavitha.P, et al / Journal of Pharmacreations Vol-2(2) 2015 [30-32]
30
Pharmacreations |Vol. 2 | Issue 2 | April-June-2015
Journal Home page: www.pharmacreations.com
Research article Open Access
Influence of patient counseling on medication adherence in epileptic patients
Kavitha. P*
, Manu . P.M, Mufeed, Sattanathan. K, Sambath Kumar. R
J.K.K.Nattraja College of Pharmacy, Kumarapalayam, Tamilnadu – 638 183, India.
*Corresponding author: Kavitha.P
E-mail id: kavitha.p119@gmail.com
ABSTRACT
The study was to examine the patient care services and pharmacist intervention for the promotion adherence to the
treatment for epilepsy, evaluate the effects of patient education or patient counseling, or both on treatment
completion in people requiring treatment for epilepsy and improve medication adherence among persons with
epilepsy by implementing simple, but time-intensive interventions to evaluate the medication knowledge achieved
by conventional verbal education and the influence of patient counseling in patients with epilepsy. Drug compliance
and sources of information of the patients were also examined. Participants were 200 patients and children were 50
with epilepsy at a neurological clinic in erode district that were referred by their neurologist. The impact of the study
was examined under by giving counseling to patients taking antiepileptic drugs on both adherence and non
adherences are also explored.
Keywords: Epilepsy, Patient counseling.
INTRODUCTION
Epilepsy is a common neurological disorder which
demands immediate medical attention and often long
term therapy.1
The overall aim in treating epilepsy
should be complete control of seizures, without
causing any untoward reaction due to medication. A
recent study in Bangalore, India reported that the
problem is nearly two and half times higher in rural
areas as compared to urban areas, where they are not
receiving any treatment. The work was to study the
influence of patient counseling on medication
adherence in epileptic patients.
STUDY CRITERIA
Inclusive criteria
Children under the age 5-11years, Male 12-70 years,
and Female 12-70 years.
Exclusive criteria
Accidental patients, Stroke patients, Pregnant &
lactating patients, Psychiatric patients, and Neonates.
METHODOLOGY
In this study was conducted in people of Erode
district, both in urban and rural population patients.
Patient selection was done on the basis of clinical
diagnosis of epilepsy and those who have been
treated with anti-epileptic drug therapy.2,3
The
patients were randomly selected for patient
counseling in out-patients department in Erode
district at Tertiary care Neurology hospital for a
period of six months, from August 2013 to January
2014. Patient counseling with a total of 250 patients
50 were children, 200 were adults (100 males & 100
female) which examined the effects of different
Journal of Pharmacreations](https://image.slidesharecdn.com/01-191217064819/85/Influence-of-patient-counseling-on-medication-adherence-in-epileptic-patients-1-320.jpg)
![Kavitha.P, et al / Journal of Pharmacreations Vol-2(2) 2015 [30-32]
31
diagnosis and give counseling interventions on
adherence to treatment of epilepsy patent counseling
was done by the pharmacist for epileptic patients in
hospital for children and to their care givers.
Adolescences were counseled in hospital and through
home visit.
RESULTS
The patients were randomly selected for patient
counseling, with a total of 250 patients, which
examined the effects of different educational and
counseling interventions on adherence to treatment
for epilepsy. The studies were reported that the
proportion of people who successfully completed
treatment for epilepsy. Overall, education or
counseling interventions increase successful
treatment completion but the magnitude of benefit is
likely to vary depending on the nature of the
intervention, and the setting. At the end of the study
70% to 85% treatment effectiveness increased in the
children and 60%in Females and 75% in Males.
Adherence was less effective in females are when
compared to males and children due to adverse
effects of the drugs and non-adherence.
DISCUSSION
Epilepsy is a neurological disorder that is
characterized by recurrent, abnormal, and
unprovoked seizures. This occurs due to hyper
excitation of neuron. Diagnosis can be done by brain
scan (positron emission tomography, single photon
emission computed tomography, magnetic resonance
imaging, computed tomography), EEG, blood test
etc.
For individuals with epilepsy, adherence to
medication is crucial in preventing or minimizing
seizures and their cumulative impact on everyday
life. Non-adherence to antiepileptic drugs (AEDs)
can result in breakthrough seizures many months or
years after a previous episode and can have serious
repercussions on an individual’s perceived quality of
life. Reasons for non-adherence are complex and
multilayered. Recently the concept of concordance
has been promoted as a possible replacement to the
notions of compliance or adherence, advocating a
decision-making process where patients can feel
more comfortable with their treatment. The
promotion of concordance involves re-thinking the
relationship between clinician and patient, and this is
likely to be a gradual process. An important finding
of this study is that patients with epilepsy have better
management behaviors with respect to their AEDs
than other health aspects related to epilepsy
(information, safety, seizure, and lifestyle).
An explanation for our results is that patients
received counseling about medication adherence
more extensively than other aspects of epilepsy
management. We believe this is the case in our and
other medical practices. Most practitioners tend to
spend more time discussing medication adherence
and side effects than discussing other social and
safety issues related to epilepsy. It is routine clinical
practice to reinforce medication adherence. This
study highlights that other factors should not be
ignored. Regular discussions with patients could
include, but not be limited to, coping with the loss of
independence, dealing with embarrassment, getting
proper sleep, eating right, and/or attempting to better
manage stress. Our data indicate where patients’
weakness and therefore may benefit from increased
counseling in these other areas.
CONCLUSION
It is evident that if patient’s seizures are not
controlled by one AED there may be no point
changing to another if the reason for lack of efficacy
is non-compliance. Based on study shows that the
proper patient counseling and patient education was
important for the improvement of therapy in Epileptic
patients.
The goal is not strict and absolute compliance but
rather improvements in therapeutic response, which
will be achieved by improvement in compliance with
prescribed therapy on the basis of effective
communication between the physician and the
patient/caregiver concerning the response, problems
with following the regimen, or adverse reaction to a
drug. Communication is essential to ensure that
physician and patient are working toward mutually
agreed-on objectives. Pediatricians must continue to
advocate for better health and appropriate
therapeutics for their patients. Key conclusions from
these studies are that the assessment of compliance
should be a routine part of the management of
epilepsy and physicians should consider pre-scribing](https://image.slidesharecdn.com/01-191217064819/85/Influence-of-patient-counseling-on-medication-adherence-in-epileptic-patients-2-320.jpg)
![Kavitha.P, et al / Journal of Pharmacreations Vol-2(2) 2015 [30-32]
32
the simplest regimen with the fewest daily doses and
tablets.
SIGNIFICANCE
This work may benefit to practicing Pharm D
students, clinical pharmacist and physician and other
health care professionals. Epilepsy is a chronic
disorder that continues to be a huge economic
burden. Although newer AEDs aim to increase
treatment success and decrease the risk for adverse
effects, there is still a strong need for improving
patient outcomes. Patient adherence is important for
improving the symptoms of epilepsy.4,5
This work
helps to conclude that there is a relation between
epilepsy and patient adherence.
Based on study shows that the proper patient
counseling and patient education was important for
the improvement of therapy in Epileptic patients.
The goal is not strict and absolute compliance but
rather improvements in therapeutic response, which
will be achieved by improvement in compliance with
prescribed therapy on the basis of effective
communication between the physician and the
patient/caregiver concerning the response, problems
with following the regimen, or adverse reaction to a
drug. Communication is essential to ensure that
physician and patient are working toward mutually
agreed-on objectives. Pediatricians must continue to
advocate for better health and appropriate
therapeutics for their patients. Good communication
with patients and families, education in health
matters, negotiation of treatments and treatment
regimens, and adoption of responsibility by patients
and families for the success of the therapy will stand
long into the future as foundations of successful
health care.
BIBLIOGRAPHY
[1] Eatock J, Baker GA. Managing patient adherence and quality of life in epilepsy. Neuropsychiatry Dis
Treat. 2007; 3: 117-131.
[2] Wagner J. Antiepileptic drug nonadherence in children with epilepsy: Outcomes and potential intervention.
Neurology.2014; 8: 278-286.
[3] Chapman SC, Horne R, Chater A, Hukins D, Smithson WH. Patients perspectives on antiepileptic
medication: Relationships between beliefs about medicines and adherence among patients with epilepsy in
UK primary care. EpilepsyBehav.2014; 31: 312-320.
[4] Al-Aqeel S, Al-Sabhan J. Strategies for improving adherence to antiepileptic drug treatment in patients
with epilepsy. Cochrane Database Syst Rev. 2011; 9: 512-524.
[5] Hui Y , Ahmad N, Makmor BM. Pathogenesis of Epilepsy: Challenges in Animal Models. Iran J Basic
Med Sci. 2013; 16: 1119-1132.](https://image.slidesharecdn.com/01-191217064819/85/Influence-of-patient-counseling-on-medication-adherence-in-epileptic-patients-3-320.jpg)
Influence of patient counseling on medication adherence in epileptic patients
- 1. Kavitha.P, et al / Journal of Pharmacreations Vol-2(2) 2015 [30-32] 30 Pharmacreations |Vol. 2 | Issue 2 | April-June-2015 Journal Home page: www.pharmacreations.com Research article Open Access Influence of patient counseling on medication adherence in epileptic patients Kavitha. P* , Manu . P.M, Mufeed, Sattanathan. K, Sambath Kumar. R J.K.K.Nattraja College of Pharmacy, Kumarapalayam, Tamilnadu – 638 183, India. *Corresponding author: Kavitha.P E-mail id: [email protected] ABSTRACT The study was to examine the patient care services and pharmacist intervention for the promotion adherence to the treatment for epilepsy, evaluate the effects of patient education or patient counseling, or both on treatment completion in people requiring treatment for epilepsy and improve medication adherence among persons with epilepsy by implementing simple, but time-intensive interventions to evaluate the medication knowledge achieved by conventional verbal education and the influence of patient counseling in patients with epilepsy. Drug compliance and sources of information of the patients were also examined. Participants were 200 patients and children were 50 with epilepsy at a neurological clinic in erode district that were referred by their neurologist. The impact of the study was examined under by giving counseling to patients taking antiepileptic drugs on both adherence and non adherences are also explored. Keywords: Epilepsy, Patient counseling. INTRODUCTION Epilepsy is a common neurological disorder which demands immediate medical attention and often long term therapy.1 The overall aim in treating epilepsy should be complete control of seizures, without causing any untoward reaction due to medication. A recent study in Bangalore, India reported that the problem is nearly two and half times higher in rural areas as compared to urban areas, where they are not receiving any treatment. The work was to study the influence of patient counseling on medication adherence in epileptic patients. STUDY CRITERIA Inclusive criteria Children under the age 5-11years, Male 12-70 years, and Female 12-70 years. Exclusive criteria Accidental patients, Stroke patients, Pregnant & lactating patients, Psychiatric patients, and Neonates. METHODOLOGY In this study was conducted in people of Erode district, both in urban and rural population patients. Patient selection was done on the basis of clinical diagnosis of epilepsy and those who have been treated with anti-epileptic drug therapy.2,3 The patients were randomly selected for patient counseling in out-patients department in Erode district at Tertiary care Neurology hospital for a period of six months, from August 2013 to January 2014. Patient counseling with a total of 250 patients 50 were children, 200 were adults (100 males & 100 female) which examined the effects of different Journal of Pharmacreations
- 2. Kavitha.P, et al / Journal of Pharmacreations Vol-2(2) 2015 [30-32] 31 diagnosis and give counseling interventions on adherence to treatment of epilepsy patent counseling was done by the pharmacist for epileptic patients in hospital for children and to their care givers. Adolescences were counseled in hospital and through home visit. RESULTS The patients were randomly selected for patient counseling, with a total of 250 patients, which examined the effects of different educational and counseling interventions on adherence to treatment for epilepsy. The studies were reported that the proportion of people who successfully completed treatment for epilepsy. Overall, education or counseling interventions increase successful treatment completion but the magnitude of benefit is likely to vary depending on the nature of the intervention, and the setting. At the end of the study 70% to 85% treatment effectiveness increased in the children and 60%in Females and 75% in Males. Adherence was less effective in females are when compared to males and children due to adverse effects of the drugs and non-adherence. DISCUSSION Epilepsy is a neurological disorder that is characterized by recurrent, abnormal, and unprovoked seizures. This occurs due to hyper excitation of neuron. Diagnosis can be done by brain scan (positron emission tomography, single photon emission computed tomography, magnetic resonance imaging, computed tomography), EEG, blood test etc. For individuals with epilepsy, adherence to medication is crucial in preventing or minimizing seizures and their cumulative impact on everyday life. Non-adherence to antiepileptic drugs (AEDs) can result in breakthrough seizures many months or years after a previous episode and can have serious repercussions on an individual’s perceived quality of life. Reasons for non-adherence are complex and multilayered. Recently the concept of concordance has been promoted as a possible replacement to the notions of compliance or adherence, advocating a decision-making process where patients can feel more comfortable with their treatment. The promotion of concordance involves re-thinking the relationship between clinician and patient, and this is likely to be a gradual process. An important finding of this study is that patients with epilepsy have better management behaviors with respect to their AEDs than other health aspects related to epilepsy (information, safety, seizure, and lifestyle). An explanation for our results is that patients received counseling about medication adherence more extensively than other aspects of epilepsy management. We believe this is the case in our and other medical practices. Most practitioners tend to spend more time discussing medication adherence and side effects than discussing other social and safety issues related to epilepsy. It is routine clinical practice to reinforce medication adherence. This study highlights that other factors should not be ignored. Regular discussions with patients could include, but not be limited to, coping with the loss of independence, dealing with embarrassment, getting proper sleep, eating right, and/or attempting to better manage stress. Our data indicate where patients’ weakness and therefore may benefit from increased counseling in these other areas. CONCLUSION It is evident that if patient’s seizures are not controlled by one AED there may be no point changing to another if the reason for lack of efficacy is non-compliance. Based on study shows that the proper patient counseling and patient education was important for the improvement of therapy in Epileptic patients. The goal is not strict and absolute compliance but rather improvements in therapeutic response, which will be achieved by improvement in compliance with prescribed therapy on the basis of effective communication between the physician and the patient/caregiver concerning the response, problems with following the regimen, or adverse reaction to a drug. Communication is essential to ensure that physician and patient are working toward mutually agreed-on objectives. Pediatricians must continue to advocate for better health and appropriate therapeutics for their patients. Key conclusions from these studies are that the assessment of compliance should be a routine part of the management of epilepsy and physicians should consider pre-scribing
- 3. Kavitha.P, et al / Journal of Pharmacreations Vol-2(2) 2015 [30-32] 32 the simplest regimen with the fewest daily doses and tablets. SIGNIFICANCE This work may benefit to practicing Pharm D students, clinical pharmacist and physician and other health care professionals. Epilepsy is a chronic disorder that continues to be a huge economic burden. Although newer AEDs aim to increase treatment success and decrease the risk for adverse effects, there is still a strong need for improving patient outcomes. Patient adherence is important for improving the symptoms of epilepsy.4,5 This work helps to conclude that there is a relation between epilepsy and patient adherence. Based on study shows that the proper patient counseling and patient education was important for the improvement of therapy in Epileptic patients. The goal is not strict and absolute compliance but rather improvements in therapeutic response, which will be achieved by improvement in compliance with prescribed therapy on the basis of effective communication between the physician and the patient/caregiver concerning the response, problems with following the regimen, or adverse reaction to a drug. Communication is essential to ensure that physician and patient are working toward mutually agreed-on objectives. Pediatricians must continue to advocate for better health and appropriate therapeutics for their patients. Good communication with patients and families, education in health matters, negotiation of treatments and treatment regimens, and adoption of responsibility by patients and families for the success of the therapy will stand long into the future as foundations of successful health care. BIBLIOGRAPHY [1] Eatock J, Baker GA. Managing patient adherence and quality of life in epilepsy. Neuropsychiatry Dis Treat. 2007; 3: 117-131. [2] Wagner J. Antiepileptic drug nonadherence in children with epilepsy: Outcomes and potential intervention. Neurology.2014; 8: 278-286. [3] Chapman SC, Horne R, Chater A, Hukins D, Smithson WH. Patients perspectives on antiepileptic medication: Relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care. EpilepsyBehav.2014; 31: 312-320. [4] Al-Aqeel S, Al-Sabhan J. Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy. Cochrane Database Syst Rev. 2011; 9: 512-524. [5] Hui Y , Ahmad N, Makmor BM. Pathogenesis of Epilepsy: Challenges in Animal Models. Iran J Basic Med Sci. 2013; 16: 1119-1132.