Development and reliability of a correction factor for parent-reported adherence to pediatric antiepileptic drug therapy.

PURPOSE: Study aims were (1) to document and examine associations between parent-report and electronic monitoring (EM) of pediatric antiepileptic drug (AED) adherence, (2) to determine the sensitivity and specificity of parent-reported adherence, and (3) to develop a correction factor for parent-reported adherence.
METHODS: Participants included 111 consecutive children with new-onset epilepsy (M(age) = 7.2 ± 2.0; 61.3% male; 75.8% Caucasian) and their primary caregivers. AED adherence was electronically monitored for 3 months prior to the 4-month clinic follow-up visit. Parent-reported adherence captured adherence 1-week prior to the clinic visit. For specificity/sensitivity analyses of parent-reported adherence, cut points of 50%, 80%, and 90% were used with electronically monitored adherence calculated 1-week prior to the clinic visit as the reference criterion. KEY
FINDINGS: Electronically monitored adherence (80.3%) was significantly lower than parent-reported adherence (96.5%; p < 0.0001) 1-week prior to the clinic visit, but both were significantly correlated (rho = 0.46, p < 0.001). The 90% parent-reported adherence cut point demonstrated the most sensitivity and specificity to electronically monitored adherence; however, specificity was still only 28%. A correction factor of 0.83 was identified as a reliable adjustment for parent-reported adherence when compared to electronically monitored adherence. SIGNIFICANCE: Although EM is the gold standard of adherence measurement for pediatric epilepsy, it is often not clinically feasible to integrate it into routine clinical care. Therefore, use of a correction factor for interpreting parent-reported adherence holds promise as a reliable clinical tool. With reliable adherence measurement, clinicians can provide adherence interventions with the hope of optimizing health outcomes for children with epilepsy. Wiley Periodicals, Inc.