ArticleEpilepsia open2025
Facilitators and barriers of antiseizure medication adherence from Australian healthcare providers' perspectives: A qualitative study.
Article in Epilepsia open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
objectivesAntiseizure medications (ASMs) are the mainstay of epilepsy treatment. Two-thirds of people with epilepsy can become seizure-free with appropriately selected ASMs. Adherence to ASMs is crucial for achieving seizure control. Unfortunately, treatment gaps prevent many people from accessing or adhering to ASMs. We aimed to understand the factors that promote and hinder ASM adherence in a high-income country, from healthcare providers' perspectives, and practical strategies to address these. Healthcare providers have accumulated decades of experience in the healthcare system through hundreds of patient encounters, and this study complements existing research focused on patients' perspectives.
methodsSemi-structured interviews were conducted with 16 purposively sampled epilepsy healthcare providers (GPs, epilepsy nurses, general neurologists, and epileptologists) each with 7-35 years' experience of managing epilepsy, located throughout Australia. Transcripts were inductively coded, thematically analyzed, and identified factors were mapped to the WHO's Five Dimensions of Medication Adherence framework: (i) patient-related, (ii) condition-related, (iii) therapy-related, (iv) health systems-related, and (v) social determinants of health.
resultsTwenty-three barriers and 16 facilitators were identified across the WHO Five Dimensions. Key barriers included lifestyle factors, health beliefs, acceptance of the diagnosis, and long wait times with limited access to services. Facilitators included the provision of tailored, epilepsy-specific information, strong clinician-patient relationships, acting on patient-identified goals and motivators, and integrated health systems. Personalized education and written materials were considered beneficial for patients' medication self-management and adherence to medication regimens. The need for regular reviews and accessible healthcare services to support ongoing adherence was highlighted. SIGNIFICANCE: Addressing modifiable factors that influence ASM adherence is a pragmatic step to addressing epilepsy treatment gaps. Findings from this study, combined with knowledge gained from the lived experience of participants, may inform the co-design of practical, point of care interventions to support medication adherence for people living with epilepsy. PLAIN LANGUAGE SUMMARY: This study identified key facilitators and barriers of antiseizure medication adherence, according to epilepsy healthcare providers in Australia. Factors impacting medication adherence were mapped to the WHO's Five Dimensions of Medication Adherence. Identified facilitators and barriers to adherence included strong clinician-patient relationships, seizure type and severity, lifestyle and life stage, adverse medication effects, and having good social support networks. This study may guide information and interventions designed to improve antiseizure medication adherence.
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