Posts Tagged ‘white coat adherence’

One-month adherence in children with new-onset epilepsy: white-coat compliance does not occur.

09/08/2008 , 9:43 AM by Alex Sicre

Today’s Medication Adherence related abstract comes from Medscape.

OBJECTIVES:
Adherence to antiepileptic drug therapy plays an important role in the effectiveness of pharmacologic treatment of epilepsy. The purpose of this study was to use an objective measure of adherence to (1) document patterns of adherence for the first month of therapy for children with new-onset epilepsy, (2) examine differences in adherence by demographic and epilepsy variables, and (3) determine whether treatment adherence improves for a short time before a clinic visit (eg, “white-coat compliance”).

METHODS:
Participants included 35 children with new-onset epilepsy (mean age: 7.2 years; 34% female; 66% white) and their caregivers. Children had a diagnosis of partial (60%), generalized (29%), or unclassified (11%) epilepsy. Adherence to treatment was electronically monitored with Medication Event Monitoring System TrackCap, starting with the first antiepileptic drug dose. Adherence was calculated across a 1-month period and for the 1, 3, and 5 days before and 3 days after the clinic appointment.

RESULTS:
Adherence for the first month of treatment in children with new-onset epilepsy was 79.4%. One-month adherence was higher in children of married parents and those with higher socioeconomic status but did not correlate with child’s gender, age, epilepsy type, prescribed medication, seizure frequency, or length of time since seizure onset. Adherence across the entire 1-month period was not different from adherence for the 1, 3, or 5 days before or 3 days after the clinic visit.

CONCLUSIONS:
Poor adherence seen for children with new-onset epilepsy during the first month of antiepileptic drug therapy is a cause for concern. Several demographic variables influence adherence to treatment, whereas the proximity to a clinic visit does not. Additional studies are needed to document whether this trend continues longitudinally and determine the clinical impact of poor adherence.

MY COMMENTS:
I wonder if the adherence rates dropping has something to do with the caregivers? 79% is not that bad – better than average – but it is only for 1 month, and with a severe affliction such as epilepsy, being able to see the effects of non-adherence has a serious impact.

White Coat Adherence

06/14/2007 , 1:50 PM by Alex Sicre

One of the questions I always have is about the white coat adherence – i.e. before you go to the dentist you floss like mad for two days and when she asks, you say, “Oh, of course I floss everyday”. Your dentist knows if you floss or not. Just like your doctor knows if you have been taking your cholesterol drugs or not. Your blood test won’t lie for you.

I admit that if you do not have any apparent symptoms you will forget to take your medication from time to time or you will stop taking your antibiotics once the infection has gone away – but you need to stay on that medication for a reason. For it’s full run. Or ask your doctor.

Unfortunately I have been very noncompliant (it doesn’t sound as good as naughty) with a script I filled for Lamacil. I can’t take it due to another medication and its possible side effects on my liver, but it was prescribed to me. I did fill it. It is sitting in my drawer with my other medications. The results of not taking it are very apparent. So I am not going to say I have been taking it, I’m just going to wait til my tests come back and she says I can take it. BUT it could end up like 70% of all medication in America and not be consumed.

Off topic, but I wanted to include a couple of facts from Dr. H. Gottlieb’s report (thanks to Jen Milman from the Healthcare Intelligence Network for the info):
40 to 60% of patients could not correctly report medication expectations 10 to 80 minutes after physicians provided information, AND
More than 60% of patients misunderstood prescription directions immediately after doctor visits.

I think that is astounding. How can this be corrected?