Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
为了确定在社区和初级卫生保健工作者的支持下，家庭护理是否能提高抗癫痫药物的依从性，癫痫控制,在资源贫乏的国家，在社区样本中，癫痫患者的生活质量超过常规诊所护理。
参与者包括在贫困社区的人口调查中确定的同意患有活动性癫痫的个体。干预措施包括提供抗癫痫药物，由初级卫生保健同等工作者提供的依从性强化和癫痫自我和污名管理指导。在持续24个月的整群随机试验中，我们将干预组与常规临床护理组进行了比较。主要结果是抗癫痫药物依从性，从每月的药丸计数评估。通过每月癫痫发作总数和首次发作时间以及癫痫个人影响量表的影响来评估癫痫发作结果。
报名于2017年9月25日开始，并于2018年7月24日完成。二十四个集群，每人包括十个癫痫患者，被随机分配到家庭或临床护理。家庭护理接受者更有可能用完每月分配的癫痫药物库存（回归系数：0.585；95％置信区间，0.289-0.881；P=0.001），癫痫发作较少（回归系数：-2.060；95CI，-3.335至-0.785；P=0.002）。更多的人从诊所护理（n=44;37％）比家庭护理（n=23;19％）退出试验（P=0.003）。第一次癫痫发作的时间，两组患者的不良反应和癫痫的个人影响相似.
与资源有限社区的临床护理相比，癫痫的家庭护理可提高药物依从性和癫痫发作结果，并减少继发性癫痫治疗差距。
参与者包括在贫困社区的人口调查中确定的同意患有活动性癫痫的个体。干预措施包括提供抗癫痫药物，由初级卫生保健同等工作者提供的依从性强化和癫痫自我和污名管理指导。在持续24个月的整群随机试验中，我们将干预组与常规临床护理组进行了比较。主要结果是抗癫痫药物依从性，从每月的药丸计数评估。通过每月癫痫发作总数和首次发作时间以及癫痫个人影响量表的影响来评估癫痫发作结果。
报名于2017年9月25日开始，并于2018年7月24日完成。二十四个集群，每人包括十个癫痫患者，被随机分配到家庭或临床护理。家庭护理接受者更有可能用完每月分配的癫痫药物库存（回归系数：0.585；95％置信区间，0.289-0.881；P=0.001），癫痫发作较少（回归系数：-2.060；95CI，-3.335至-0.785；P=0.002）。更多的人从诊所护理（n=44;37％）比家庭护理（n=23;19％）退出试验（P=0.003）。第一次癫痫发作的时间，两组患者的不良反应和癫痫的个人影响相似.
与资源有限社区的临床护理相比，癫痫的家庭护理可提高药物依从性和癫痫发作结果，并减少继发性癫痫治疗差距。
