Development of a toolkit to improve prescribing appropriateness for children with epilepsy

Supervisors:

• Professor David Wright, d.j.wright@leicester.ac.uk
• Dr Sion Scott S.Scott@ leicester.ac.uk
• Charlotte Lawthom (NHS)

Project Description :

3 Year Funded PhD open to UK/Home applicants only

Background

 Adherence to medication in children and young people (CYP) with epilepsy measured by objective assessment is estimated to be 58%(1) with non-adherence to medication closely associated with poorer seizure outcomes.(2)

Evidence from randomised controlled trials suggest that medication adherence may be improved through education and behavioural interventions.(3, 4) Better quality trials with longer follow up periods are however recommended.(4)  Theory informed and developed interventions have not been trialled in this population and there is limited evidence understanding of how children and young people (CYP) self-manage their therapy.(5)  CYP might be traditionally viewed as disempowered and therefore less likely to be engaged in concordance with a treatment plan but increasingly agreement in treatment plans is recognised as an important factor (6).

To develop effective intervention to improve medication adherence in CYP it is therefore important to understand barriers and enablers, including both physical and non-physical to medication adherence.  Socioeconomic factors such as parental education, annual income and marital status are all known to be related to non-adherence.(7) The impact of types of medication and numbers of medication on non-adherence is however less clear.(1) With increasing numbers of CYP focused medication formulations becoming routinely available, opportunities to improve medication adherence through better prescribing decisions and formulation selection may require inclusion in the design of future complex interventions for CYP with epilepsy.

The aim of the project is to develop a toolkit for prescribers to enhance the appropriateness of prescribing and support for children and young people with epilepsy to improve medication adherence.

Method

 This PhD will be designed to identify the barriers and enablers to epilepsy non-adherence in CYP through the systematic review of the literature, qualitative research methods and potentially analysis of big-data.  A large-scale survey of CYP with epilepsy may be included to ensure generalisability of findings.

Having identified a range of barriers and enablers to medication adherence; the PhD student will work with CYP with epilepsy to co-create and design a complex intervention for evaluation within a future feasibility study and definitive trial.

References

1. Yang C, Hao Z, Yu D, Xu Q, Zhang L. The prevalence rates of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy: A systematic review and meta analysis. Epilepsy Res. 2018;142:88-99.
2. Modi AC, Wu YP, Rausch JR, Peugh JL, Glauser TA. Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes. Neurology. 2014;83(22):2085-90.
3. Godara K, Phakey N, Garg D, Sharma S, Das RR. Interventions to Improve Medication Adherence in Children With Epilepsy: A Systematic Review. Cureus. 2024.
4. Al-Aqeel S, Gershuni O, Al-Sabhan J, Hiligsmann M. Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy. Cochrane Database of Systematic Reviews. 2017.
5. Mooney O, McNicholl A, Lambert V, Gallagher P. Self-management in children and young people with epilepsy: A systematic review and qualitative meta-synthesis. J Health Psychol. 2021;26(1):126-39.
6. Sanz EJ. Concordance and children's use of medicines. BMJ. 2003 Oct 11;327(7419):858-60. doi: 10.1136/bmj.327.7419.858. PMID: 14551105; PMCID: PMC214037.
7. Huber R, Weber P. Is there a relationship between socioeconomic factors and prevalence, adherence and outcome in childhood epilepsy? A systematic scoping review. Eur J Paediatr Neurol. 2022;38:1-6.