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Spanos S, Hutchinson K, Ryder T, Rapport F, Goodwin N, Zurynski Y. Integrated Care in Epilepsy Management: A Scoping Review of the Models and Components of Health and Social Care Delivery. Int J Integr Care 2024; 24:18. [PMID: 38463746 PMCID: PMC10921962 DOI: 10.5334/ijic.7659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
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.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Karen Hutchinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Tayhla Ryder
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- CanTeen Australia, Sydney, Australia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nicholas Goodwin
- Central Coast Local Health District, Gosford, NSW, Australia
- Central Coast Research Institute for Integrated Care, University of Newcastle, Gosford, NSW, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Hutchinson K, Ryder T, Coleman H, Nullwala R, Herkes G, Bleasel A, Nikpour A, Wong C, Todd L, Ireland C, Shears G, Bartley M, Groot W, Kerr M, Vagholkar S, Braithwaite J, Rapport F. Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy. J Clin Nurs 2022. [PMID: 36494199 DOI: 10.1111/jocn.16582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/28/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study is to enhance the understanding of the core elements and influencing factors on the community-based epilepsy nurse's role and responsibilities. BACKGROUND Internationally, epilepsy nurse specialists play a key role in providing person-centred care and management of epilepsy but there is a gap in understanding of their role in the community. DESIGN A national three-stage, mixed-method study was conducted. METHODS One-on-one, in-depth semi-structured qualitative interviews were conducted online with 12 community-based epilepsy nurses (Stage 1); retrospective analysis of data collected from the National Epilepsy Line, a nurse-led community helpline (Stage 2); and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting. RESULTS Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role diversity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID-19 pandemic experiences, role boundaries, funding, and resource availability. CONCLUSION Community epilepsy nurses play a pivotal role in providing holistic, person-centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery. RELEVANCE TO CLINICAL PRACTICE Epilepsy nurses' person-centred approach to epilepsy management is influenced by the limited investment in epilepsy-specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice. NO PATIENT OR PUBLIC CONTRIBUTION Only epilepsy nurses' perspectives were sought.
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Affiliation(s)
- Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Honor Coleman
- Melbourne School of Psychological Science, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Geoffrey Herkes
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Andrew Bleasel
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Armin Nikpour
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Chong Wong
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lisa Todd
- Epilepsy Action Australia, North Ryde, New South Wales, Australia
| | - Carol Ireland
- Epilepsy Action Australia, North Ryde, New South Wales, Australia
| | | | - Melissa Bartley
- Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Wendy Groot
- Epilepsy Australia, Melbourne, Victoria, Australia.,Epilepsy Tasmania, Launceston, Tasmania, Australia
| | - Michael Kerr
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Sanjyot Vagholkar
- MQ Health General Practice, Macquarie University, North Ryde, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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Power K, McCrea Z, White M, Breen A, Dunleavy B, O'Donoghue S, Jacquemard T, Lambert V, El-Naggar H, Delanty N, Doherty C, Fitzsimons M. The development of an epilepsy electronic patient portal: Facilitating both patient empowerment and remote clinician-patient interaction in a post-COVID-19 world. Epilepsia 2020; 61:1894-1905. [PMID: 32668026 PMCID: PMC7404863 DOI: 10.1111/epi.16627] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/15/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
Objectives The current coronavirus disease 2019 (COVID‐19) pandemic stresses an urgency to accelerate much‐needed health service reform. Rapid and courageous changes being made to address the immediate impact of the pandemic are demonstrating that the means and technology to enable new models of health care exist. For example, innovations such as electronic patient portals (ePortal) can facilitate (a) radical reform of outpatient care; (b) cost containment in the economically constrained aftermath of the pandemic; (c) environmental sustainability by reduction of unnecessary journeys/transport. Herein, the development of Providing Individualised Services and Care in Epilepsy (PiSCES), an ePortal to the Irish National Epilepsy Electronic Patient Record, is demonstrated. This project, which pre‐dates the COVID‐19 crisis, aims to facilitate better patient‐ and family‐centered epilepsy care. Methods A combination of ethnographic research, document analysis, and joint application design sessions was used to elicit PiSCES requirements. From these, a specification of desired modules of functionality was established and guided the software development. Results PiSCES functional features include “My Epilepsy Care Summary,” “My Epilepsy Care Goals,” “My Epilepsy Clinic Letters,” “Help Us Measure Your Progress,” “Prepare For Your Clinic Visit,” “Information for Your Healthcare Provider.” The system provides people with epilepsy access to, and engages them as co‐authors of, their own medical record. It can promote improved patient‐clinician partnerships and facilitate patient self‐management. Significance In the aftermath of COVID‐19, it is highly unlikely that the healthcare sector will return to a “business as usual” way of delivering services. The pandemic is expected to accelerate adoption of innovations like PiSCES. It is therefore a catalyst for change that will deliver care that is more responsive to individual patient needs and preferences.
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Affiliation(s)
- Kevin Power
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zita McCrea
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maire White
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Annette Breen
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | | | | | - Tim Jacquemard
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Hany El-Naggar
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Norman Delanty
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, Beaumont Hospital, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colin Doherty
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology, St. James's Hospital, Dublin, Ireland
| | - Mary Fitzsimons
- Future Neuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences (PBS), The Royal College of Surgeons in Ireland, Dublin, Ireland
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