NEW HAVEN, CT — While care of epilepsy patients tends to be high quality at the VHA, not enough emphasis is placed on education and counseling, according to a new study.
A report in Epilepsy & Behavior pointed out that specific quality indicators and performance measures for the condition have been published and revised on numerous occasions. But, even though epilepsy-specific quality measures have been demonstrated in some healthcare systems, researchers from the1 Connecticut VA Healthcare System and the Yale School of Medicine and colleagues sought to gather information on changes in epilepsy performance measures over time and across settings in a national sample.1
They explained that the VA healthcare system, the nation’s largest, provided that opportunity, allowing the study of changes in epilepsy-specific performance over time, in acute vs. chronic epilepsy care and in primary vs. specialty care.
To do that, the study team performed chart extractions of newly diagnosed epilepsy and chronic care of veterans with epilepsy within the healthcare system. The authors determined epilepsy-specific performance measures based on the Quality Indicators in Epilepsy Treatment (QUIET) VA measurement for each veteran with epilepsy.
Analysis focused on differences in care across time (2009, 2012 and 2014), as well as source of epilepsy care (primary care only, neurology only and shared care between neurology and primary care).
Researchers reported that chart reviews of 2,386 veterans—1,125 of them women—included 281 (10.5%) receiving acute care and 2,105 (89.5%) receiving chronic care. Results indicated that, across all years:
- 203 (72.5%) had electroencephalograph ordered/performed;
- 225 (80.4%) had neuroimaging ordered/performed;
- 106 (37.9%) were instructed about driving precautions;
- 71 (25.4%) were educated about safety and injury prevention; and
- 251 (89.6%) had anti-seizure medication monotherapy initiated.
The study noted that the proportion of patients with new-onset seizures educated about diagnosis and type of seizure increased over time 30 (34.9%) in 2008, 42 (43.8%) in 2012 and 52 (53.1%).
In addition, of the 2,105 veterans receiving chronic care, 41.1% of encounters documented compliance of anti-seizure medication, while 17.15% addressed driving restrictions, 63.9% documented general education and counseling, 11.9% documented safety and injury prevention, 23.2% documented medication side effects, and 22.0% documented discussion of treatment options.
“With chronic epilepsy care, documentation of quality measures did not change with time,” the authors advised. “Veterans who were co-managed by primary care and neurology had a higher proportion of driving instruction and safety instructions compared to neurology or primary care alone.”
The study found that, overall, epilepsy performance measures were high—greater than 70% of new-onset epilepsy—for documentation diagnostic procedures, such as EEG and neuroimaging. They were low, however, across crucial educational and counseling measures, at less than 50%.
“Despite the emphasis on the importance of psychosocial education and holistic management in the academic literature, through advocacy work and during professional meetings, there was not a significant improvement in education and counseling over time,” the authors wrote. “Some aspects of psychosocial education were performed better among primary care providers compared to neurologists. However, more attention and work need to be dedicated on implementing and documenting education and counseling people with epilepsy in the clinical setting.”
- Altalib H, McMillan KK, Padilla S, Pugh MJ. Epilepsy quality performance in a national sample of neurologists and primary care providers: Characterizing trends in acute and chronic care management. Epilepsy Behav. 2021 Aug 31;123:108218. doi: 10.1016/j.yebeh.2021.108218. Epub ahead of print. PMID: 34479039.