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      Neuropsychiatric Disease and Treatment (submit here)

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      Managing patient adherence and quality of life in epilepsy

      review-article
      ,
      Neuropsychiatric Disease and Treatment
      Dove Medical Press
      adherence, compliance, antiepileptic drugs, epilepsy, QOL

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          Abstract

          Patient adherence to medication continues to be a cause of concern within the medical profession. This review examines the various methods of quantifying the level of patient adherence, progress in predicting causes of non-adherence, and the implications for its management. Contributions from the medical, health belief, and psychosocial models are discussed in order to highlight how the concept of adherence has changed over time. The impact of epilepsy, seizures, and taking antiepileptic drugs (AEDs) on both adherence and quality of life are also explored. The volume and quality of previous research conducted has enabled a number of predictive factors to be identified, from which various strategies have been developed. While this review concentrates on potential strategies in managing treatment adherence within epilepsy, findings can equally be applied to other chronic conditions.

          Most cited references86

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          Adherence to Medication

          New England Journal of Medicine, 353(5), 487-497
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            Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice.

            K C Farmer (1999)
            Researchers and clinicians have used numerous methods in their attempts to adequately assess patient compliance (adherence) with medication regimens and to identify noncompliant patients. Large variations have been reported in the extent of noncompliance in individual patients and large populations. In addition, nonadherence has often been poorly defined. Direct measures of adherence include drug assays of blood or urine, use of drug markers with the target medication, and direct observation of the patient receiving the medication. Indirect measures of adherence imply that the medication has been used by the patient; these measures include various forms of self-reporting by the patient, medication measurement (pill count), use of electronic monitoring devices, and review of prescription records and claims. Compliance measures should be assessed on the basis of their validity (sensitivity and specificity or statistical correlation) and the reference standard used. Many early studies used pill counts as a reference standard, but electronic monitoring devices such as the Medication Event Monitoring System have replaced pill counts as the reference standard. The choice of a method for measuring adherence to a medication regimen should be based on the usefulness and reliability of the method in light of the researcher's or clinician's goals. Specific methods may be more applicable to certain situations, depending on the type of adherence being assessed, the precision required, and the intended application of the results.
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              Patient adherence to treatment: three decades of research. A comprehensive review.

              Low compliance to prescribed medical interventions is an ever present and complex problem, especially for patients with a chronic illness. With increasing numbers of medications shown to do more good than harm when taken as prescibed, low compliance is a major problem in health care. Relevant studies were retrieved through comprehensive searches of different database systems to enable a thorough assessment of the major issues in compliance to prescribed medical interventions. The term compliance is the main term used in this review because the majority of papers reviewed used this term. Three decades have passed since the first workshop on compliance research. It is timely to pause and to reflect on the accumulated knowledge. The enormous amount of quantitative research undertaken is of variable methodological quality, with no gold standard for the measurement of compliance and it is often not clear which type of non-compliance is being studied. Many authors do not even feel the need to define adherence. Often absent in the research on compliance is the patient, although the concordance model points at the importance of the patient's agreement and harmony in the doctor-patient relationship. The backbone of the concordance model is the patient as a decision maker and a cornerstone is professional empathy. Recently, some qualitative research has identified important issues such as the quality of the doctor-patient relationship and patient health beliefs in this context. Because non-compliance remains a major health problem, more high quality studies are needed to assess these aspects and systematic reviews/meta-analyses are required to study the effects of compliance in enhancing the effects of interventions.
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                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatric Disease and Treatment
                Neuropsychiatric Disease and Treatment
                Dove Medical Press
                1176-6328
                1178-2021
                February 2007
                : 3
                : 1
                : 117-131
                Affiliations
                Division of Neurological Science, University of Liverpool, UK
                Author notes
                Correspondence: Gus A Baker, University Department of Neurological Science, Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool L9 7LJ, UK, Tel +44 151 529 5691, Fax +44 0151 529 5465, Email G.Baker@ 123456liverpool.ac.uk
                Article
                ndt-3-117
                10.2147/nedt.2007.3.1.117
                2654533
                19300542
                8615885b-4140-40e8-9377-f46690a71d06
                © 2007 Dove Medical Press Limited. All rights reserved
                History
                Categories
                Reviews

                Neurology
                adherence,epilepsy,qol,compliance,antiepileptic drugs
                Neurology
                adherence, epilepsy, qol, compliance, antiepileptic drugs

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