UK general practice: Continuing to fail in the care of people with epilepsy?

Integrated Care in Epilepsy Management: A Scoping Review of the Models and Components of Health and Social Care Delivery

Introduction

Epilepsy is the most common neurological condition globally. Integrating health and social care is fundamental in epilepsy management, but the scope of progress in this area is unclear. This scoping review aimed to capture the range and type of integrated care components and models in epilepsy management.

Methods

Four databases were searched for articles published since 2010 that reported on integrated care in epilepsy. Data were extracted and synthesised into components of integrated care that had been implemented or recommended only. Models of integrated care were identified, and their components tabulated.

Results

Fifteen common and interrelated components of integrated care emerged that were aligned with four broad areas: healthcare staff and pathways (e.g., epilepsy nurses); tasks and services (e.g., care coordination); education and engagement (e.g., shared decision making); and technology for diagnosis and communication (e.g., telehealth). Twelve models of integrated care were identified; seven were implemented and five were recommended.

Discussion

There is a growing evidence-base supporting integrated, person-centred epilepsy care, but implementation is challenged by entrenched silos, underdeveloped pathways for care, and deficits in epilepsy education.

Conclusion

Integrating epilepsy care relies on changes to workforce development and policy frameworks to support whole-of-system vision for improving care.

Evaluation of the knowledge, awareness, and attitudes toward epilepsy among general practitioners in Eastern China

OBJECTIVE

We aimed to assess the knowledge, awareness, and attitudes toward epilepsy among general practitioners (GPs) from community health service centers (CHCs) in Hangzhou, Eastern China.

METHODS

One hundred twenty three GPs working at CHCs participated in this cross-sectional study in 2022. A custom-built electronic questionnaire, which comprised four domains, including 12 items for general condition data, 10 items for awareness (including first aid), a 16-item scale for attitudes, and 6 items for demographic data, was administered to the GPs. Descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis H test, and Spearman's rank correlation analysis were used to analyze the non-normal distribution of the data set.

RESULTS

The GPs' average score on the awareness of epilepsy section was 18.14 ± 3.34 (aggregate score: 34), the first aid knowledge of epilepsy section scored 4.89 ± 1.54 (aggregate score: 7), and the epilepsy attitude section scored 62.28 ± 10.15 (aggregate score: 80). Age (r_s = 0.218, P = 0.015), professional title (r_s = 0.215, P = 0.017), and length of service (r_s = 0.240, P = 0.008) correlated significantly with mean awareness of epilepsy scores. Age (r_s = -0.234, P = 0.009) and educational background (r_s = 0.199, P = 0.028) correlated significantly with attitudes toward epilepsy. Furthermore, when GPs faced newly diagnosed people with epilepsy (PWE), a referral was usually recommended (89.43%) and some would give Chinese traditional treatment (13.01%). In addition, the difficulties the GPs encountered in managing included PWE rarely appearing in the community (82.93%), the community lacking corresponding medical equipment (82.11%), and GPs lacking epilepsy-related experience (73.17%).

CONCLUSION

The awareness and attitudes of GPs toward epilepsy in the CHCs were suboptimal. General practitioners age, professional title, length of service, and educational background influenced awareness and attitudes toward PWE. Effective public intervention programs, epilepsy training based on National Guidelines, and referral routes need to improve in China to enhance the care of PWE.

The impact of a clinical review of people with active epilepsy not under shared care by a GP with special interest

PURPOSE

To review clinical outcomes of a single face-to-face review of people with epilepsy (PWE) not under shared care, and any recommendations following a notes review of non-attendees and those under shared care, by a GP with Special Interest in epilepsy (GPwSIe).

METHOD

One hundred and eighty one PWE, not under shared care were invited for a review. In addition, fifty six people under shared care had a notes review. Interventional outcomes were reviewed after 12 months.

RESULTS

There had been ten deaths (all non-attributable to epilepsy), and six people had left the area, leaving 221 people who completed the audit. Fifty one percent attended for review, and were more likely to be in documented remission (p = 0.01). The frequency of annual GP epilepsy reviews in the following year did not rise significantly. There was a significant rise in vitamin D prescriptions (p < 0.001). Thirty seven DEXA scans were arranged, 76% were abnormal. There was reluctance by patients to withdraw medication, change multi dose, or subtherapeutic anti-seizure medication (ASM) regimes, even in the context of long-term seizure remission or inadequate seizure control. Three people achieved remission from changes made to ASM as a result of the review.

CONCLUSION

Review of PWE in primary care remains poor. Attitudes from both GPs and PWE to their condition needs evaluation in order to plan future care. Bone health is an issue easily addressed in primary care and should be promoted through education or the re-introduction of a specific QOF (Quality and Outcomes Framework) target. Guidance on bone health for ASM needs clarification. This study adds to the evidence of the effectiveness of a GPwSIe.