Abstracts

Rationale:


Remembering to request medication refills can be a barrier to adherence for patients with chronic conditions. Additionally, at Veterans Affairs (VA) facilities, auto-refills are not an option and therefore, patients must remember to request refills in a timely manner. Missed anti-seizure medications (ASMs) can lead to breakthrough seizures, putting patients at risk for injury and Sudden Unexpected Death in Epilepsy (SUDEP).



The current VA directive allows for local sites to implement policies allowing 90-day prescriptions of Schedule III-V controlled substances if a policy addressing patient safety and monitoring is developed.



We investigated adherence rates between 30-day vs 90-day prescriptions of ASMs at 3 different VA sites to determine if there are differences between adherence rates related to dispensed quantities. A secondary goal in gathering this data was to implement policy changes to allow 90-day prescriptions for controlled ASMs at more VA sites if data showed improved adherence and safety outcomes.








Methods:

Retrospective chart reviews were conducted from 1/2022-12/2022 on patients pulled from VA Epilepsy Centers of Excellence (ECoE) database, based on the following patient criteria.

Inclusion criteria :
-Prescribed ASMs within Veterans Health Administration (VHA)
-A seizure diagnosis
-Within the Richmond, Greater Los Angeles, and Houston VA catchment areas 

Exclusion criteria :
-ASMs regularly prescribed outside of the VA 
-Receiving ASMs for sole diagnosis other than epilepsy
-Severe non-adherence (patients who only filled ASM script once)
-Without one full year of data on medication refills
-Seizure rescue medications excluded



A Standardized Proportion of Days Covered (PDC) calculator was used to calculate adherence rates.  Additionally, charts were reviewed to assess for breakthrough seizures, emergency department (ED) visits, injuries related to seizures, etc.






Results:
A total of 708 veterans were included. Data analysis from all 3 sites showed increased adherence rates with 90-day ASM prescriptions compared to 30-day prescriptions.

Overall, 30-day supply demonstrated 85% PDC, and 90-day supply demonstrated 93% PDC. On average, Veterans with 30-day supply missed 53 days of ASMs per year and those with 90-day supply missed 25 days of ASMs per year.




Conclusions: The data demonstrates that Veterans receiving 30-day prescriptions have more missed days of ASMs per year. This suggests that 90-day prescriptions for ASMs improve medication adherence.  Patients with 90-day prescriptions had fewer breakthrough seizures, and fewer ED admissions and traumatic injuries related to these seizures compared to similar patients with 30-day prescriptions.   



The analysis of local data has led to a change in policy at the Richmond VA, now allowing certain controlled ASMs to be dispensed as 90-day supplies with 1 refill.  Houston is in the process of developing a similar policy. Los Angeles, a site with an existing 90-day supply controlled ASM policy, showed a 95% adherence rate of controlled ASMs in 2022. In the future, we hope to compare the data pre- and post-policy change to assess the effects of the implementation directly. 


Funding: n/a