A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country
Abstract Objective To ascertain whether home‐based care with community and primary healthcare workers' support improves adherence to antiseizure medications, seizure control, and quality of life over routine clinic‐based care in community samples of people with epilepsy in a resource‐poor count...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-12-01
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| Series: | Epilepsia Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/epi4.12659 |
| _version_ | 1798014477653770240 |
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| author | Gagandeep Singh Suman Sharma Namita Bansal Meenakshi Sharma Anurag Chowdhury Sarit Sharma Rajinder K. Bansal Jatinder S. Goraya Raj K. Setia Birinder S. Paul Josemir W. Sander |
| author_facet | Gagandeep Singh Suman Sharma Namita Bansal Meenakshi Sharma Anurag Chowdhury Sarit Sharma Rajinder K. Bansal Jatinder S. Goraya Raj K. Setia Birinder S. Paul Josemir W. Sander |
| author_sort | Gagandeep Singh |
| collection | DOAJ |
| description | Abstract Objective To ascertain whether home‐based care with community and primary healthcare workers' support improves adherence to antiseizure medications, seizure control, and quality of life over routine clinic‐based care in community samples of people with epilepsy in a resource‐poor country. Methods Participants included consenting individuals with active epilepsy identified in a population survey in impoverished communities. The intervention included antiseizure medication provision, adherence reinforcement and epilepsy self‐ and stigma management guidance provided by a primary health care–equivalent worker. We compared the intervention group to a routine clinic‐based care group in a cluster‐randomized trial lasting 24 months. The primary outcome was antiseizure medication adherence, appraised from monthly pill counts. Seizure outcomes were assessed by monthly seizure aggregates and time to first seizure and impact by the Personal Impact of Epilepsy scale. Results Enrolment began on September 25, 2017 and was complete by July 24, 2018. Twenty‐four clusters, each comprising ten people with epilepsy, were randomized to either home‐ or clinic‐care. Home‐care recipients were more likely to have used up their monthly‐dispensed epilepsy medicine stock (regression coefficient: 0.585; 95% confidence intervals, 0.289‐0.881; P = 0.001) and had fewer seizures (regression coefficient: −2.060; 95%CI, −3.335 to −0.785; P = 0.002). More people from clinic‐care (n = 44; 37%) than home‐care (n = 23; 19%) exited the trial (P = 0.003). The time to first seizure, adverse effects and the personal impact of epilepsy were similar in the two arms. Significance Home care for epilepsy compared to clinic care in resource‐limited communities improves medication adherence and seizure outcomes and reduces the secondary epilepsy treatment gap. |
| first_indexed | 2024-04-11T15:19:01Z |
| format | Article |
| id | doaj.art-3379538f37d84b3d937da5a825f800cf |
| institution | Directory Open Access Journal |
| issn | 2470-9239 |
| language | English |
| last_indexed | 2024-04-11T15:19:01Z |
| publishDate | 2022-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Epilepsia Open |
| spelling | doaj.art-3379538f37d84b3d937da5a825f800cf2022-12-22T04:16:25ZengWileyEpilepsia Open2470-92392022-12-017478179110.1002/epi4.12659A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited countryGagandeep Singh0Suman Sharma1Namita Bansal2Meenakshi Sharma3Anurag Chowdhury4Sarit Sharma5Rajinder K. Bansal6Jatinder S. Goraya7Raj K. Setia8Birinder S. Paul9Josemir W. Sander10Research & Development Unit Dayanand Medical College Ludhiana IndiaResearch & Development Unit Dayanand Medical College Ludhiana IndiaResearch & Development Unit Dayanand Medical College Ludhiana IndiaNon‐communicable Diseases Division Indian Council of Medical Research New Delhi IndiaDepartment of Social & Preventive Medicine Dayanand Medical College Ludhiana IndiaDepartment of Social & Preventive Medicine Dayanand Medical College Ludhiana IndiaDepartment of Neurology Dayanand Medical College Ludhiana IndiaDepartment of Paediatrics Dayanand Medical College Ludhiana IndiaPunjab Remote Sensing Centre Ludhiana IndiaDepartment of Neurology Dayanand Medical College Ludhiana IndiaUCL Queen Square Institute of Neurology London WC1N 3BG London UKAbstract Objective To ascertain whether home‐based care with community and primary healthcare workers' support improves adherence to antiseizure medications, seizure control, and quality of life over routine clinic‐based care in community samples of people with epilepsy in a resource‐poor country. Methods Participants included consenting individuals with active epilepsy identified in a population survey in impoverished communities. The intervention included antiseizure medication provision, adherence reinforcement and epilepsy self‐ and stigma management guidance provided by a primary health care–equivalent worker. We compared the intervention group to a routine clinic‐based care group in a cluster‐randomized trial lasting 24 months. The primary outcome was antiseizure medication adherence, appraised from monthly pill counts. Seizure outcomes were assessed by monthly seizure aggregates and time to first seizure and impact by the Personal Impact of Epilepsy scale. Results Enrolment began on September 25, 2017 and was complete by July 24, 2018. Twenty‐four clusters, each comprising ten people with epilepsy, were randomized to either home‐ or clinic‐care. Home‐care recipients were more likely to have used up their monthly‐dispensed epilepsy medicine stock (regression coefficient: 0.585; 95% confidence intervals, 0.289‐0.881; P = 0.001) and had fewer seizures (regression coefficient: −2.060; 95%CI, −3.335 to −0.785; P = 0.002). More people from clinic‐care (n = 44; 37%) than home‐care (n = 23; 19%) exited the trial (P = 0.003). The time to first seizure, adverse effects and the personal impact of epilepsy were similar in the two arms. Significance Home care for epilepsy compared to clinic care in resource‐limited communities improves medication adherence and seizure outcomes and reduces the secondary epilepsy treatment gap.https://doi.org/10.1002/epi4.12659adherencelow‐ and middle‐income countriespersonal impactsecondary treatment gapseizure control |
| spellingShingle | Gagandeep Singh Suman Sharma Namita Bansal Meenakshi Sharma Anurag Chowdhury Sarit Sharma Rajinder K. Bansal Jatinder S. Goraya Raj K. Setia Birinder S. Paul Josemir W. Sander A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country Epilepsia Open adherence low‐ and middle‐income countries personal impact secondary treatment gap seizure control |
| title | A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country |
| title_full | A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country |
| title_fullStr | A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country |
| title_full_unstemmed | A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country |
| title_short | A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country |
| title_sort | cluster randomized trial comparing home based primary health care and usual clinic care for epilepsy in a resource limited country |
| topic | adherence low‐ and middle‐income countries personal impact secondary treatment gap seizure control |
| url | https://doi.org/10.1002/epi4.12659 |
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