White coat adherence over the first year of therapy in pediatric epilepsy

Abstract

Objective: To examine white coat adherence over time in children with epilepsy.

Study design: This was a longitudinal prospective study to examine medication adherence prior to and following consecutive clinic visits over a 13-month period in 120 children with newly diagnosed epilepsy (M(age) = 7.2 ± 2.9 years; 38% female) and their caregivers. Electronic monitors were used to assess adherence and ordinal logistic regression models were employed.

Results: Results demonstrated white coat adherence, with adherence increasing during the 3 days preceding clinic visits. Data also revealed a significant interaction, whereby adherence increased following initial clinic visits, but decreased following the last clinic visit.

Conclusions: White coat adherence occurs for children with newly diagnosed epilepsy. Increased awareness of white coat adherence has important implications for clinical decision-making and should be examined in other pediatric populations. Increased monitoring of medication patterns can help clinicians avoid unnecessary changes to the treatment regimen. Interventions targeting improved communication around adherence behaviors are necessary to maximize therapy benefits.

Figure 1

Flow diagram of the number of participants at each time point.

Figure 2

Model-based probability of 100% versus 0 or 50% adherence for the three days before and after the clinic visit (where clinic visit = 0 on the x-axis) across five consecutive clinic visits following diagnosis (i.e., approximately 1, 4, 7, 10, and 13-months post-diagnosis). The solid circle represents the adherence probability on the day of the clinic visit.