Timothy E Welty PharmD, FCCP, BCPS is currently Professor of Pharmacy Practice at the McWhorter School of Pharmacy of Samford University in Birmingham, Alabama and Adjunct Associate Research Professor in the Department of Neurology at the University of Alabama Birmingham. He also is Continuing Education Director for PharmaCE, a part of The Annals of Pharmacotherapy and Harvey Whitney Books Company. Dr. Welty has extensive experience in hospital and ambulatory pharmacy practice as a pharmacotherapeutic specialist for Methodist Hospital of Indiana in Indianapolis. An active practitioner, educator, and researcher in neuro-pharmacotherapy, Dr. Welty has focused his research and practice in epilepsy.

Professor Timothy Welty at Samford University and the University of Alabama wanted to learn if people with epilepsy, who had difficulty with transportation to a pharmacy, were then unable to take their medication on time. To find out more about the relationship between transportation and medication compliance he posted a 22-item survey on epilepsy.com.

“One of the big questions we had is whether or not limited transportation affects people’s ability to get to a pharmacy and then take their medication on time. In looking at the literature -- within the epilepsy community -- there was no one studying this. And yet there are articles about those with other disease states such as spinal cord injury patients, those who are HIV positive, and diabetic patients. Patients in each of these groups who had difficulty with transportation experienced difficulty getting their medication. We wanted to know what this meant in the epilepsy community,” he said.

The findings

The team compiled a survey that was posted on epilepsy.com from February 5 through April 13, 2007. When Professor Welty and his team looked at the results, they found that 40 percent of the respondents said they had difficulty taking their medications as prescribed because transportation issues made it difficult to get their prescription refills in time.

There were a total of 126 people who completed the surveys and of that group, 86 were patients, 24 caregivers, and 16 from interested individuals. The respondents’ ages ranged from 19 to 71 and primarily were women. Most had insurance coverage for medications and of this group slightly more than half used mail-order pharmacies.

However of the approximately 40 percent who said they had difficulty getting prescription refills due to problems with transportation, 39 percent said that they would miss fewer doses if they had adequate transportation.

“An interesting note,” said Professor Welty, “is that it appears that regardless of whether people lived in urban or rural communities both experienced problems getting to a pharmacy.”

The driving dilemma

When asked about his concerns with regard to those with epilepsy who do drive, he observed that people who have difficulty with transportation find that it impacts them in many ways. A major concern about limited transportation and the ability to drive goes beyond lifestyle, it also affects whether or not people can stay on their medication schedule.

He said, “I think that this study points out that transportation issues are very big and extend beyond lifestyle issues such as a job or social life or family responsibilities. But what the data indicates is that it has implications for medical management. Then you weigh that against the issue of public safety. But if society needs to weigh the question of public safety and the greater good and says, ‘We don’t want those who have seizures driving’ then society must answer the question of how do we help those with seizures, who need transportation, overcome this barrier.”

Professor Welty and his colleagues recently submitted a paper to the American Epilepsy Society regarding these findings.

Edited by Steven C. Schachter, MD