Background: Nonadherence to antiepileptic drugs (AEDs) can result in suboptimal outcomes for patients.Aim: This study aimed to assess the utility of a theory-based approach to understanding patient perspectives on AEDs and adherence.Method: Patients with epilepsy, identified by a GP case note review, were mailed validated questionnaires assessing their perceptions of AEDs and their adherence to them.Results: Most (84.9%) of the 398 AED-treated respondents accepted the necessity of AEDs, but over half expressed doubts, with 55% disagreeing or uncertain about the statement 'I would prefer to take epilepsy medication than risk a seizure'. Over a third (36.4%) expressed strong concerns about the potential negative effects of AEDs. We used self-report and medication possession ratio to classify 36.4% of patients as nonadherent. Nonadherence was related to beliefs about medicines and implicit attitudes toward AEDs (p<0.05). Adherence-related attitudes toward AEDs were correlated with general beliefs about pharmaceuticals (BMQ General: General Harm, General Overuse, and General Benefit scales) and perceptions of personal sensitivity to medicines (PSM scale).Conclusion: We identified salient, adherence-related beliefs about AEDs. Patient-centered interventions to support medicine optimization for people with epilepsy should take account of these beliefs. (C) 2013 The Authors. Published by Elsevier Inc. All rights reserved.

This community-based survey of people with epilepsy who were divided into adherent and non-adherent groups used validated scales to determine factors associated with medicine non-adherence and self-management of epilepsy to identify those people at risk of poor self-management behavior or medicines non-adherence. Using demographic characteristics, it is possible to identify those people at risk during a regular epilepsy review. Adults with epilepsy were identified from general practices using clinical and drug searches with the diagnosis confirmed by case notes analysis. Four hundred thirty-eight people with epilepsy were divided into adherent and non-adherent groups using medication records and self-report of non-adherent behavior. Data were also collected on patient demographics, seizure activity and self-management behavior. Low self-management scores and recent seizures were associated with non-adherence. Young adults, those in education or employment, those living with others and those who had recent seizures were more likely to have low self-management scores.

The aim is to propose a simple way of identifying patients at risk of antiepileptic drug (AED) non-adherence during epilepsy review (a scheduled consultation to review the patient and their condition). The use of a multi-modal approach to the problem of non-adherence is necessary because of the limitations of existing methods. A mixed methodology was developed in a nested study using a case record review to calculate the medicine possession ratio (MPR) from the AED medication records of a community sample, a literature review and a consensus panel to develop a questionnaire to address how people manage their epilepsy, particularly medicine management, and how to collect information about non-adherence through stated findings in keeping with non-adherent behavior. Results show that a medicine record can be used to estimate the MPR (<80% indicates non-adherence) and that an open and non-confrontational consultation style can be fostered by using key questions within the consultation to identify those at risk of non-adherence.

AimTo suggest how to improve primary epilepsy care by assessing the strengths and weaknesses of epilepsy care in general practice by reviewing practice records in relation to qualities and outcomes framework (QOF) indicators and epilepsy guidelines.BackgroundConcerns have been raised about epilepsy care in the UK. The general practice QOF indicators offered the first opportunity to take on structured epilepsy care in the UK. The QOF includes targets for this condition and national guidelines list key priorities to improve care. This study explores how general practice systems are delivering this care.MethodsA case notes review in 27 practices in the north-east of England. Adults with epilepsy were identified from practice morbidity registers and a READ code search. Data from 1333 patients were collected on the frequency and location of epilepsy review, type of epilepsy and classification of seizures, epilepsy medication ordering, and individual and practice demographic data. The data were entered into SPSS for frequency analysis and grouped for further analysis: Primary Care Trust (PCT), age and medication ordering groups (satisfactory, moderate or poor).FindingsOf the patients, 24% did not have a record of type of epilepsy and about a third of patients had no seizure classification recorded. One-fifth of patients were not reviewed in the previous year but of those who were, the majority were seen in general practice. Seizure frequency was not recorded in the last 12 months in one-quarter of patients. Adherence and recording of seizure information were related to age of patient. Epilepsy registers were inaccurate. The findings suggest that epilepsy care can be improved by using review and monitoring systems to ensure a complete and accurate epilepsy register and appropriate annual clinical and medication review.

The aim of this qualitative study was to examine the experiences and needs of patients and carers affected by one of three common neurological conditions and to explore how primary care can contribute to improvements in care. Data was drawn from five focus groups recruited from various geographical locations in the north of England served by seven primary care trusts and four neurological departments. Researchers in a semi-rural practice recruited 38 participants, 15 of whom were male and 23 were female. Ages ranged from 26 to 74 years. The participants were either patients or carers of people with epilepsy, multiple sclerosis or Parkinson’s disease and were recruited from three settings: primary care (two groups), voluntary groups (two groups) and secondary care (one group). The results showed that neurological care could be patchy, overstretched and insensitive to the individual patients’ needs. Communication between patient and health professional, and between different sectors of the health service is poor and often leads to time wasting and delays in treatment. The impact of these conditions on the patient and their family and their preferences for treatment varies. Specialist nurses are highly valued by patients and their families but the service is overstretched and access is difficult. General practitioners (GPs) are valued for their communication skills and their ability to act as advocate for the patient; however, there are doubts about their knowledge of neurological conditions. Problems of service access were identified. The skills of health professionals in general practice can be used to complement those in secondary care. GPs and nurses are considered a valuable resource that could be used better to improve neurological care, particularly in fostering patient participation in decisions about their care. Practice-based commissioning offers an opportunity to review services to make better use of the time and skills of all professionals involved in the provision of care.