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dc.contributor.authorAskarieh, Amber
dc.contributor.authorMorrison, Ian
dc.contributor.authorRoss, Kevin
dc.contributor.authorMcCowan, Colin
dc.contributor.authorMatthews, Keith
dc.contributor.authorKidd, Brian
dc.contributor.authorHeath, Craig A.
dc.date.accessioned2022-02-20T00:39:03Z
dc.date.available2022-02-20T00:39:03Z
dc.date.issued2021-04
dc.identifier.citationAskarieh , A , Morrison , I , Ross , K , McCowan , C , Matthews , K , Kidd , B & Heath , C A 2021 , ' Medication adherence, utilisation of healthcare services and mortality of patients with epilepsy on opiate replacement therapy : a retrospective cohort study ' , Epilepsy & Behaviour , vol. 117 , 107829 . https://doi.org/10.1016/j.yebeh.2021.107829en
dc.identifier.issn1525-5050
dc.identifier.otherPURE: 272563008
dc.identifier.otherPURE UUID: 9d7fa2f5-7a62-4e3b-9a42-5266efb4394a
dc.identifier.otherORCID: /0000-0002-9466-833X/work/87846043
dc.identifier.otherScopus: 85101395766
dc.identifier.otherWOS: 000637384000028
dc.identifier.urihttp://hdl.handle.net/10023/24911
dc.descriptionFunding: This research was supported by a grant from TENOVUS Scotland, a national charity supporting medical research and involved in the improvement of healthcare within Scotland, UK.en
dc.description.abstractIntroduction: Substance misuse is not uncommonly recognized in people with epilepsy (PWE). Mortality is significantly greater in those with comorbid substance misuse, but it remains unclear whether epilepsy care and management contribute to this. This cohort study aimed to compare the rates of mortality in PWE receiving opiate replacement therapy (ORT) and PWE alone, as well as evaluate their medication adherence, levels of engagement with epilepsy services as currently delivered, and utilization of unscheduled hospital care. Material and methods: A 5-year historical cohort for PWE was identified and manually validated using electronic patient records registered with NHS Tayside. Overall incidence rates for mortality and contact with emergency health care services were calculated for PWE receiving ORT and PWE alone. Engagement with outpatient epilepsy services was also noted. Adherence to antiepileptic drugs (AEDs) was expressed in terms of medication possession ratio (MPR). Results: Of the 1297 PWE attending a tertiary care epilepsy service, 68 (5.3%) PWE were receiving ORT. The mortality rate was significantly greater in PWE on ORT in comparison to PWE only (7.4% vs 1.7 %; P < 0.05; relative risk of death: 4.34, 95% CI 1.19–15.7), as well as the incidence of emergency healthcare services contact being higher (24.5% vs 17.7%; P < 0.05; incidence rate ratio: 1.39, 95% CI: 1.12–1.71). Poor adherence to AEDs was also more common in PWE on ORT (28.4% vs 23.5%; P = 0.02), as well as failure to engage with elective outpatient services (8.4% vs 3.0%; P < 0.05; rate ratio 2.77, 95% CI: 1.86–4.1). Conclusion: People with epilepsy on ORT are less likely to engage with elective epilepsy services as currently delivered or take AEDs as prescribed despite most of these patients having daily attendance at a community pharmacist. This may contribute to the significantly increased rates of mortality and unscheduled hospital care. Clinicians and policymakers should consider service redesign to meet the demands of this high-risk population in an attempt to reduce mortality and morbidity
dc.format.extent4
dc.language.isoeng
dc.relation.ispartofEpilepsy & Behaviouren
dc.rightsCopyright © 2021 Elsevier Inc. All rights reserved. This work has been made available online in accordance with publisher policies or with permission. Permission for further reuse of this content should be sought from the publisher or the rights holder. This is the author created accepted manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at https://doi.org/10.1016/j.yebeh.2021.107829.en
dc.subjectEpilepsyen
dc.subjectOpiateen
dc.subjectMethadoneen
dc.subjectMortalityen
dc.subjectAdherenceen
dc.subjectAntiepileptic drugsen
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.subjectRM Therapeutics. Pharmacologyen
dc.subjectI-PWen
dc.subject.lccRA0421en
dc.subject.lccRMen
dc.titleMedication adherence, utilisation of healthcare services and mortality of patients with epilepsy on opiate replacement therapy : a retrospective cohort studyen
dc.typeJournal articleen
dc.description.versionPostprinten
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.contributor.institutionUniversity of St Andrews. Sir James Mackenzie Institute for Early Diagnosisen
dc.contributor.institutionUniversity of St Andrews. Population and Behavioural Science Divisionen
dc.identifier.doihttps://doi.org/10.1016/j.yebeh.2021.107829
dc.description.statusPeer revieweden
dc.date.embargoedUntil2022-02-20


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