Pharmacist-assessed medication adherence and quality of life in patients with epilepsy.

Abstract

Background: Epilepsy affects approximately 65 million individuals globally, with medication adherence a critical determinant of seizure control and quality of life (QoL). Community pharmacists, with their accessibility and expertise, are well positioned to support adherence and patient education. However, little is known about the interplay between adherence, readiness for change, and QoL in patients with epilepsy (PWE) in Cyprus. This study is the first comprehensive investigation in Cyprus, addressing this evidence gap and highlighting opportunities for pharmacist-led interventions.

Methods: This cross-sectional study (Sep 2022 - Oct 2023) was conducted at Limassol General Hospital. Greek-speaking adult PWE (N = 85) were assessed via semi-structured telephone interviews using validated tools: Morisky Medication Adherence Scale (MMAS-8), Medication Adherence Report Scale (MARS-5), Readiness for Change Ruler, and Quality of Life in Epilepsy Inventory (QOLIE-31). Ethical approval was obtained from the Cyprus National Bioethics Committee (EEBK EP2019.01.130). Statistical analyses included t-tests, ANOVA, and binary logistic regression using SPSS v28 (p < 0.05).

Results: High adherence was reported by 55.3% (MMAS-8) and 63.5% (MARS-5). Adherence type was significantly associated with QoL (Kruskal-Wallis H = 11.427, p = 0.010), with mixed non-adherence linked to poorer QoL (Bonferroni p = 0.014). The mean QOLIE-31 score was 75.3 (SD = 19.91), significantly higher than Greek (69.6; p = 0.010, Cohen's D = 0.286) and U.S. (62.9, p < 0.001, Cohen's D = 0.623) reference values. Employment (p = 0.009) was positively associated with QoL. Higher MARS-5 scores (≥4.8) and high/medium MMAS-8 scores (≥6) were significant predictors of better QoL (MARS-5: p = 0.003, OR = 4.826, 95% CI 1.738-13.401; MMAS-8: p = 0.004, OR = 7.125, 95% CI 1.899-26.729). Readiness for change was high (mean 9.48/10), largely driven by trust in physicians.

Conclusion: This Cyprus-based study demonstrates strong associations between adherence, sociodemographic factors, and QoL in PWE. The novel adherence sub-classification provides valuable insights for personalised care. Community pharmacists can play a pivotal role in improving adherence, delivering patient-centred education, and enhancing epilepsy management via integrated multidisciplinary care.