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Bagayoko T, Houot M, Navarro V, Herlin B, Dupont S. Discriminating factors in access to video-EEG for epilepsy surgery in a French tertiary epilepsy center. Rev Neurol (Paris) 2024:S0035-3787(24)00520-4. [PMID: 38806360 DOI: 10.1016/j.neurol.2024.04.003] [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: 02/01/2024] [Revised: 03/26/2024] [Accepted: 04/06/2024] [Indexed: 05/30/2024]
Abstract
Equitable access to care and management is a priority for patients with epilepsy and may vary depending on each country's healthcare system. As this issue has not been specifically addressed in France, we conducted a retrospective study to identify discriminating factors in access to surgery at a French tertiary epilepsy center. Initially, we examined factors previously identified in other countries as influential in surgery access, including age at diagnosis, affected side, gender, years of education, socio-professional categories, and density of general practitioners in the residential area, in 293 consecutive French-native patients with refractory medial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS). Subsequently, we conducted a case-control study comparing patients born in France with 22 patients born abroad to specifically explore migratory status. The analysis revealed that the only three factors statistically influencing the delay between the onset of epilepsy and entry into video-EEG were early age at onset (associated with a longer delay), pensioner status (associated with a longer delay), and student status (associated with a shorter delay). Migratory status, gender, and socio-economic level (indirectly reflected by the level of education and socio-professional category) were not found to be discriminatory factors in access to video-EEG. Discrepancies between our study and foreign studies may be attributed to differences in healthcare systems and medical coverage among countries. Efforts in France to improve access to surgery should focus on enhancing communication among practitioners to promptly refer any MTLE-HS patient to an epilepsy surgery center, regardless of their age.
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Affiliation(s)
- T Bagayoko
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - M Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital Paris, Paris, France
| | - V Navarro
- AP-HP, Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France; Paris Brain Institute (ICM), Inserm, CNRS, Pitié-Salpêtrière Hospital Paris, Paris, France
| | - B Herlin
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - S Dupont
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; AP-HP, Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France; Paris Brain Institute (ICM), Inserm, CNRS, Pitié-Salpêtrière Hospital Paris, Paris, France.
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Rasmussen SP, Schougaard LMV, Hjøllund NH, Christiansen DH. Patient-reported outcome measures as determinants for the utilization of health care among outpatients with epilepsy: a prognostic cohort study. J Patient Rep Outcomes 2023; 7:103. [PMID: 37861867 PMCID: PMC10589170 DOI: 10.1186/s41687-023-00641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures can inform clinical decision making and planning of treatment in the health care system. The aim of this study was to examine whether patient-reported health domains influence the use of health care services in outpatients with epilepsy. METHODS This was a prognostic cohort study of 2,426 epilepsy outpatients referred to PRO-based follow-up at the Department of Neurology, Aarhus University Hospital, Denmark. Patients filled out a questionnaire covering health literacy areas, self-efficacy, well-being and general health. The main outcome was a record of contact to the epilepsy outpatient clinic, inpatient ward and/or emergency room within 1 year, retrieved from health register data. Associations were analysed by multivariable binomial logistic regression. RESULTS A total of 2,017 patients responded to the questionnaire and 1,961 were included in the final analyses. An outpatient contact was more likely among patients with very low health literacy ('social support'): odds ratio (OR) 1.5 (95% CI: 1.1-2.1), very low and low self-efficacy: OR 1.7 (95% CI: 1.2-2.3) and OR 1.4 (95% CI: 1.0-1.8), low and medium well-being: OR 2.2 (95% CI: 1.6-3.0) and OR 1.4 (95% CI: 1.1-1.9), and patients rating their general health as fair: OR 2.8 (95% CI: 1.7-4.6). Inpatient contact and emergency room contact were associated with the health domains of self-efficacy and general health. CONCLUSIONS PRO questionnaire data indicated that patients with low health literacy ("social support"), well-being, self-efficacy and self-rated general health had an increased use of health care services at 1 year.These results suggest that PRO measures may provide useful information in relation to the possibility of proactive efforts and prevention of disease-related issues and to help identify efficiency options regarding resource utilization.
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Affiliation(s)
- Stine Primdahl Rasmussen
- Department of Occupational Medicine, Danish Ramazzini Centre, Gødstrup Hospital, Hospitalsparken 15, Herning, 7400, Denmark
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
| | - Liv Marit Valen Schougaard
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
| | - Niels Henrik Hjøllund
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Møllegade 16, Herning, 7400, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, Danish Ramazzini Centre, Gødstrup Hospital, Hospitalsparken 15, Herning, 7400, Denmark.
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark.
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1A, Silkeborg, 8600, Denmark.
- Centre for Research in Health and Nursing, Research, Regional Hospital Central Jutland, Heibergs Allé 2K, Viborg, 8800, Denmark.
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Atacan Yaşgüçlükal M, Ünlütürk Z. What is the price of residence in rural areas for patients with epilepsy? Neurol Res 2023; 45:695-700. [PMID: 36919513 DOI: 10.1080/01616412.2023.2188521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION We aimed to investigate the effects of the urban or rural dwelling of patients with epilepsy living in Giresun on their use of health services, quality of life, and self-efficacy. METHODS In this cross-sectional study, patients with epilepsy who were admitted to the neurology outpatient clinic between January 2022 and August 2022 were evaluated. All the participants were individually interviewed to complete the Epilepsy Self-Efficacy Scale (ESES) and Quality of Life in Epilepsy Inventory (QOLIE-10) questionnaire. The frequency of admission to the emergency department, neurology outpatient clinic, and general practitioner clinic where the primary reason for the visit was epilepsy in the last year was determined using the hospital database. RESULTS This study was composed of 109 patients. The rural dwelling was found in 45% of the participants. The mean age of seizure onset was significantly lower in patients dwelling in rural areas Mean GP and ED visits didn't differ according to dwelling. On the other hand, mean neurology outpatient clinic visits were significantly lower in patients living in rural areas. The QOLIE-10 didn't differ according to the dwelling. However, lower ESES results were obtained in patients living in rural areas. CONCLUSION This study shows that there is a disparity in neurologist visits among patients with epilepsy dwelling in rural areas. Furthermore, lower ESES scores were found in these patients. Educational interventions should be addressed particularly to the patients dwelling in rural areas to strengthen self-efficacy, and fill the gaps for the shortage of health personnel and qualified health care.
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Affiliation(s)
| | - Zeynep Ünlütürk
- Neurology Department, Derince Training and Research Hospital, Kocaeli, Turkey
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Kandregula S, Terrell D, Beyl R, Freelin A, Guthikonda B, Notarianni C, Toms J. Racial and socioeconomic disparities in the advanced treatment of medically intractable pediatric epilepsy. Neurosurg Focus 2022; 53:E2. [DOI: 10.3171/2022.7.focus22338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/21/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE
Racial and ethnic disparities in healthcare have gained significant importance since the Institute of Medicine published its report on disparities in healthcare. There is a lack of evidence on how race and ethnicity affect access to advanced treatment of pediatric medically intractable epilepsy. In this context, the authors analyzed the latest Kids’ Inpatient Database (KID) for racial/ethnic disparities in access to surgical treatment of epilepsy.
METHODS
The authors queried the KID for the years 2016 and 2019 for the diagnosis of medically intractable epilepsy.
RESULTS
A total of 29,292 patients were included in the sample. Of these patients, 8.9% (n = 2610) underwent surgical treatment/invasive monitoring. The mean ages in the surgical treatment and nonsurgical treatment groups were 11.73 years (SD 5.75 years) and 9.5 years (SD 6.16 years), respectively. The most common insurance in the surgical group was private/commercial (55.9%) and Medicaid in the nonsurgical group (47.7%) (p < 0.001). White patients accounted for the most common population in both groups, followed by Hispanic patients. African American patients made up 7.9% in the surgical treatment group compared with 12.9% in the nonsurgical group. African American (41.1%) and Hispanic (29.9%) patients had higher rates of emergency department (ED) utilization compared with the White population (24.6%). After adjusting for all covariates, the odds of surgical treatment increased with increasing age (OR 1.06, 95% CI 1.053–1.067; p < 0.001). African American race (OR 0.513, 95% CI 0.443–0.605; p < 0.001), Hispanic ethnicity (OR 0.681, 95% CI 0.612–0.758; p < 0.001), and other races (OR 0.789, 95% CI 0.689–0.903; p = 0.006) had lower surgical treatment odds compared with the White population. Medicaid/Medicare was associated with lower surgical treatment odds than private/commercial insurance (OR 0.603, 0.554–0.657; p < 0.001). Interaction analysis revealed that African American (OR 0.708, 95% CI 0.569–0.880; p = 0.001) and Hispanic (OR 0.671, 95% CI 0.556–0.809; p < 0.001) populations with private insurance had lower surgical treatment odds than White populations with private insurance. Similarly, African American patients, Hispanic patients, and patients of other races with nonprivate insurance also had lower surgical treatment odds than their White counterparts after adjusting for all other covariates.
CONCLUSIONS
Based on the KID, African American and Hispanic populations had lower surgical treatment rates than their White counterparts, with higher utilization of the ED for pediatric medically intractable epilepsy.
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Affiliation(s)
| | | | - Robbie Beyl
- Department of Statistics, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Anne Freelin
- Department of Neurosurgery, LSU Health Shreveport; and
| | | | | | - Jamie Toms
- Department of Neurosurgery, LSU Health Shreveport; and
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Pellinen J. Treatment gaps in epilepsy. FRONTIERS IN EPIDEMIOLOGY 2022; 2:976039. [PMID: 38455298 PMCID: PMC10910960 DOI: 10.3389/fepid.2022.976039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 03/09/2024]
Abstract
Over 50 million people around the world have epilepsy, and yet, epilepsy recognition and access to care are ongoing issues. Nearly 80% of people with epilepsy live in low-and middle-income countries and face the greatest barriers to quality care. However, there are substantial disparities in care within different communities in high-income countries as well. Across the world, under-recognition of seizures continues to be an issue, leading to diagnostic and treatment delays. This stems from issues surrounding stigma, public education, basic access to care, as well as healthcare worker education. In different regions, people may face language barriers, economic barriers, and technological barriers to timely diagnosis and treatment. Even once diagnosed, people with epilepsy often face gaps in optimal seizure control with the use of antiseizure medications. Additionally, nearly one-third of people with epilepsy may be candidates for epilepsy surgery, and many either do not have access to surgical centers or are not referred for surgical evaluation. Even those who do often experience delays in care. The purpose of this review is to highlight barriers to care for people with epilepsy, including issues surrounding seizure recognition, diagnosis of epilepsy, and the initiation and optimization of treatment.
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Hatoum R, Nathoo-Khedri N, Shlobin NA, Wang A, Weil AG, Fallah A. Barriers to Epilepsy Surgery in Pediatric Patients: A Scoping Review. Seizure 2022; 102:83-95. [DOI: 10.1016/j.seizure.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/05/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
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Tulleners R, Blythe R, Dionisio S, Carter H. Resource use and costs associated with epilepsy in the Queensland hospital system: protocol for a population-based data linkage study. BMJ Open 2021; 11:e050070. [PMID: 34876425 PMCID: PMC8655588 DOI: 10.1136/bmjopen-2021-050070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Epilepsy places a large burden on health systems, with hospitalisations for seizures alone occurring more frequently than those related to diabetes. However, the cost of epilepsy to the Australian health system is not well understood. The primary aim of this study is to quantify the health service use and cost of epilepsy in Queensland, Australia. Secondary aims are to identify differences in health service use and cost across population and disease subgroups, and to explore the associations between health service use and common comorbidities. METHODS AND ANALYSIS This project will use data linkage to identify the health service utilisation and costs associated with epilepsy. A base cohort of patients will be identified from the Queensland Hospital Admitted Patient Data Collection. We will select all patients admitted between 2014 and 2018 with a diagnosis classification related to epilepsy. Two comparison cohorts will also be identified. Retrospective hospital admissions data will be linked with emergency department presentations, clinical costing data, specialist outpatient and allied health occasions of service data and mortality data. The level of health service use in Queensland, and costs associated with this, will be quantified using descriptive statistics. Difference in health service costs between groups will be explored using logistic regression. Linear regression will be used to model the associations of interest. The analysis will adjust for confounders including age, sex, comorbidities, indigenous status, and remoteness. ETHICS AND DISSEMINATION Ethical approval has been obtained through the QUT University Human Research Ethics Committee (1900000333). Permission to waive consent has been granted under the Public Health Act 2005, with approval provided by all relevant data custodians. Findings of the proposed research will be communicated through presentations at national and international conferences, presentations to key stakeholders and decision-makers, and publications in international peer-reviewed journals.
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Affiliation(s)
- Ruth Tulleners
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Robin Blythe
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sasha Dionisio
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Hannah Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Vigneault LP, Diendere E, Sohier-Poirier C, Abi Hanna M, Poirier A, St-Onge M. Acute health care among Indigenous patients in Canada: a scoping review. Int J Circumpolar Health 2021; 80:1946324. [PMID: 34320910 PMCID: PMC8330756 DOI: 10.1080/22423982.2021.1946324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
A recent report by the Chief Public Health Officer of Canada demonstrates the inferior health status of Indigenous Peoples in Canada when compared to non-Indigenous populations. This scoping review maps out the available literature concerning acute health care for Indigenous Peoples in Canada in order to better understand the health care issues they face. All existing articles concerning health care provided to Indigenous Peoples in Canada in acute settings were included in this review. The targeted studied outcomes were access to care, health care satisfaction, hospital visit rates, mortality, quality of care, length of stay and cost per hospitalisation. 114 articles were identified. The most studied outcomes were hospitalisation rates (58.8%), length of stay (28.0%), mortality (25.4%) and quality of care (24.6%) Frequently studied topics included pulmonary disease, injuries, cardiovascular disease and mental illness. Indigenous Peoples presented lower levels of satisfaction and access to care although they tend to be over-represented in hospitalisation rates for acute care. Greater inclusion of Indigenous Peoples in the health care system and in the training of health care providers is necessary to ensure a better quality of care that is culturally safe for Indigenous Peoples.
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Affiliation(s)
| | - Ella Diendere
- Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec, Canada
| | | | - Margo Abi Hanna
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Annie Poirier
- Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
| | - Maude St-Onge
- Département de médecine familiale et de médecine d'urgence, Université Laval, Quebec, Canada
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Duke SM, Otárula KAG, Canales T, Lu E, Stout A, Ghearing GR, Sajatovic M. A systematic literature review of health disparities among rural people with epilepsy (RPWE) in the United States and Canada. Epilepsy Behav 2021; 122:108181. [PMID: 34252832 PMCID: PMC8429139 DOI: 10.1016/j.yebeh.2021.108181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Epilepsy is a leading cause of global disease burden, with people with epilepsy (PWE) experiencing adverse health outcomes related to the psychiatric comorbidities and socioeconomic consequences of the disorder. Rural populations are more likely to be impoverished or uninsured, which could impact health outcomes for rural-dwelling PWE (RPWE). AIMS This systematic literature review identified original research studying health disparities and outcomes among RPWE in the United States and Canada to (1) characterize the disparities faced by RPWE and (2) elucidate the effects of these disparities upon clinical outcomes. METHODS We performed a systematic search of six electronic databases: Pubmed, Cochrane, PsychInfo, Web of Science, Scopus, and Ovid. Articles considered were original research reports conducted in Canada or the United States before August 2020. A modified Newcastle Ottawa Scale was used to assess the quality of the included studies. RESULTS Our search returned 2093 articles that examined the health disparities of RPWE, of which six met criteria for this review. Outcome measures of health disparity included in these papers were mortality (2; 33%), use of health resources (2; 33%), and epilepsy prevalence (2; 33%). Only one paper (16%) concluded that RPWE experienced worse health outcomes relative to urban-dwelling PWE, while 5 (84%) found no difference. CONCLUSION Our study did not find sufficient evidence that RPWE in the US and Canada experience significant health disparities compared to similar urban populations of PWE. More research using prospective studies and datasets allowing better characterization of rurality is required.
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Affiliation(s)
- Sean M. Duke
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
| | - Karina A. González Otárula
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Thomas Canales
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
| | - Elaine Lu
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
| | - Amber Stout
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
| | - Gena R. Ghearing
- Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Martha Sajatovic
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, 10900 Euclid Ave. Cleveland, OH, 44106, USA
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Mandge V, Correa DJ, McGinley J, Boro A, Legatt AD, Haut SR. Factors associated with patients not proceeding with proposed resective epilepsy surgery. Seizure 2021; 91:402-408. [PMID: 34303161 DOI: 10.1016/j.seizure.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study evaluated the association between eligible patients not proceeding with resective epilepsy surgery and various demographic, disease-specific, and epilepsy-evaluation variables. METHODS This retrospective case-control study included patients identified as candidates for resective epilepsy surgery at the Montefiore Medical Center between January 1, 2009 and June 30, 2017. Chi-squared, two-tailed, independent sample t-test, Mann-Whitney U test and logistic regression were utilized to identify variables associated with patients not proceeding with surgery. RESULTS Among the 159 potential surgical candidates reviewed over the 8.5-year study period, only 53 ultimately proceeded with surgery (33%). Eighty-seven (55%) out of these 159 patients were identified as appropriate for resective epilepsy surgery during the study period. Thirty-four (39%) of these 87 patients did not proceed with surgery. Variables independently correlated (either positively or negatively) with the patient not proceeding with surgery were: being employed [Odds Ratio (OR) 4.2, 95% confidence interval (CI) 1.12-15.73], temporal lobe lesion on MRI (OR 0.35, 95% CI 0.14-0.84), temporal lobe EEG ictal onsets (OR 0.21, 95% CI 0.07-0.62), and temporal lobe epileptogenic zone (OR 0.19, 95% CI 0.07-0.55). CONCLUSION The novel finding in this study is the association between employment status and whether the patient had epilepsy surgery: employed patients were 4.2 times more likely to not proceed with surgery compared to unemployed patients. In addition, patients with a temporal lobe lesion on MRI, temporal lobe EEG ictal onsets, and/or a temporal epileptogenic zone were more likely to proceed with surgery. Future work will be needed to evaluate these findings prospectively, determine if they generalize to other patient populations, explore the decision whether or not to proceed with epilepsy surgery from a patient-centered perspective, and suggest strategies to reduce barriers to this underutilized treatment.
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Affiliation(s)
- Vishal Mandge
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, United States.
| | - Daniel José Correa
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - John McGinley
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Alexis Boro
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Alan D Legatt
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Sheryl R Haut
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
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Samanta D, Ostendorf AP, Willis E, Singh R, Gedela S, Arya R, Scott Perry M. Underutilization of epilepsy surgery: Part I: A scoping review of barriers. Epilepsy Behav 2021; 117:107837. [PMID: 33610461 PMCID: PMC8035287 DOI: 10.1016/j.yebeh.2021.107837] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/15/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
One-third of persons with epilepsy have seizures despite appropriate medical therapy. Drug resistant epilepsy (DRE) is associated with neurocognitive and psychological decline, poor quality of life, increased risk of premature death, and greater economic burden. Epilepsy surgery is an effective and safe treatment for a subset of people with DRE but remains one of the most underutilized evidence-based treatments in modern medicine. The reasons for this quality gap are insufficiently understood. In this comprehensive review, we compile known significant barriers to epilepsy surgery, originating from both patient/family-related factors and physician/health system components. Important patient-related factors include individual and epilepsy characteristics which bias towards continued preferential use of poorly effective medications, as well as patient perspectives and misconceptions of surgical risks and benefits. Health system and physician-related barriers include demonstrable knowledge gaps among physicians, inadequate access to comprehensive epilepsy centers, complex presurgical evaluations, insufficient research, and socioeconomic bias when choosing appropriate surgical candidates.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Adam P Ostendorf
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Erin Willis
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rani Singh
- Department of Pediatrics, Atrium Health/Levine Children's Hospital, USA
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, USA
| | - Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Freedman DA, Grinspan Z, Glynn P, Mittlesteadt J, Dawes A, Patel AD. Validating Coding for the Identification of Pediatric Treatment Resistant Epilepsy Patients. Child Neurol Open 2021; 8:2329048X211037806. [PMID: 34514022 PMCID: PMC8424723 DOI: 10.1177/2329048x211037806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
The International Classification of Diseases (ICD) system includes sub codes to indicate that an individual with epilepsy is treatment resistant. These codes would be a valuable tool to identify individuals for quality improvement and population health, as well as for recruitment into clinical trials. However, the accuracy of these codes is unclear. We performed a single center cross sectional study to understand the accuracy of ICD codes for treatment resistant epilepsy. We identified 344 individuals, roughly half with treatment resistant epilepsy The ICD code had a sensitivity of 90% (147 of 164) and specificity of 86% (155 of 180). The miscoding of children with refractory epilepsy was attributed to the following reasons: 5 patients had epilepsy surgery, 4 had absence epilepsy, 4 patients were seen by different providers, and 1 patient was most recently seen in movement disorders clinic. ICD codes accurately identify children with treatment resistant epilepsy.
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Affiliation(s)
| | | | - Peter Glynn
- Nationwide Children's
Hospital, Columbus, OH, USA
| | | | - Alex Dawes
- Nationwide Children's
Hospital, Columbus, OH, USA
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Shah BR, Slater M, Frymire E, Jacklin K, Sutherland R, Khan S, Walker JD, Green ME. Use of the health care system by Ontario First Nations people with diabetes: a population-based study. CMAJ Open 2020; 8:E313-E318. [PMID: 32371525 PMCID: PMC7207033 DOI: 10.9778/cmajo.20200043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND First Nations people in Ontario have an increased prevalence of diabetes compared to other people in the province. This study examined use of health care services by First Nations people with diabetes and other people with diabetes in Ontario. METHODS Using linked health administrative databases, we identified all people in Ontario with diabetes as of Apr. 1, 2014. We identified First Nations people using the Indian Register. We looked at outcomes from Apr. 1, 2014, to Mar. 31, 2015. We determined the proportion of people with a regular family physician and their continuity of care with that physician. We also examined visits with specialists for diabetes care, hospital admissions for ambulatory-care-sensitive conditions, and emergency department visits for hypo- or hyperglycemia. RESULTS There were 1 380 529 people diagnosed with diabetes in Ontario as of Apr. 1, 2014, of whom 22 952 (1.7%) were First Nations people. First Nations people were less likely to have a regular family physician (85.3% v. 97.7%) and had lower continuity of care with that physician (mean score for continuity of care 74.6 v. 77.7) than other people in Ontario. They were also less likely to see specialists. First Nations people were more likely to be admitted to hospital for ambulatory-care-sensitive conditions (2.4% v. 1.2%) and to have an emergency department visit for hypo- or hyperglycemia (1.5% v. 0.8%). Disparities were particularly marked for those living in First Nations communities. INTERPRETATION First Nations people with diabetes in Ontario had poorer access to and use of primary care than other people with diabetes in the province. These findings may help explain continued disparities in the rates of complications related to diabetes.
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Affiliation(s)
- Baiju R Shah
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont.
| | - Morgan Slater
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Eliot Frymire
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Kristen Jacklin
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Roseanne Sutherland
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Shahriar Khan
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Jennifer D Walker
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
| | - Michael E Green
- ICES (Shah, Slater, Frymire, Khan, Walker, Green); Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green) and Department of Family Medicine (Slater, Green), Queen's University, Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Chiefs of Ontario (Sutherland), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Department of Family Medicine (Green), Kingston Health Sciences Centre, Kingston, Ont
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Lystad RP, Rapport F, Bleasel A, Herkes G, Nikpour A, Mitchell R. Hospital service utilization trajectories of individuals living with epilepsy in New South Wales, Australia, 2012-2016: A population-based study. Epilepsy Behav 2020; 105:106941. [PMID: 32062105 DOI: 10.1016/j.yebeh.2020.106941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to examine five-year trajectories of hospital service utilization among individuals living with epilepsy in New South Wales (NSW), Australia, and to identify factors predictive of trajectory group membership. METHODS This study used group-based trajectory modeling of hospital admissions over a five-year period for individuals living with epilepsy who had an epilepsy-related hospitalization during 1 January 2012 and 31 December 2012 in NSW, Australia (n = 5762). RESULTS The analysis revealed the following five distinct hospital service utilization trajectory groups: "one-off users" (Group 1; 22.9%), "low-chronic users" (Group 2; 47.1%), "moderate-declining users" (Group 3; 10.3%), "moderate-chronic users" (Group 4; 18.3%), and "high-chronic users" (Group 5; 1.5%). There were key features that defined trajectory group membership, in particular the relative proportions of group members with chronic health conditions, other comorbid conditions, refractory epilepsy, and status epilepticus. For instance, "high-chronic users" (Group 5) had higher proportions of individuals with chronic health conditions (34.8%) and refractory epilepsy (19.1%); "moderate-declining users" (Group 3) had higher proportions of individuals with chronic health conditions (35.1%) and status epilepticus (9.8%); and "low-chronic users" (Group 2) had the lowest proportion of individuals with chronic health conditions. CONCLUSION It is important to gain a better understanding of hospital service utilization among individuals living with epilepsy. This research has identified trajectory groups of hospital service utilization profiles of individuals living with epilepsy. Identification of predictors of trajectory group membership allows targeting of strategies to reduce hospital admissions, inform healthcare service delivery, and improve the health and wellbeing of individuals living with epilepsy.
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Affiliation(s)
- Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Andrew Bleasel
- University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia
| | - Geoffrey Herkes
- University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia
| | - Armin Nikpour
- University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Elliott J, McCoy B, Clifford T, Potter BK, Skidmore B, Wells GA, Coyle D. Cost-effectiveness of cannabinoids for pediatric drug-resistant epilepsy: protocol for a systematic review of economic evaluations. Syst Rev 2019; 8:75. [PMID: 30917869 PMCID: PMC6436234 DOI: 10.1186/s13643-019-0990-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Drug-resistant epilepsy negatively impacts the quality of life and is associated with increased morbidity and mortality and high costs to the healthcare system. Cannabis-based treatments may be effective in reducing seizures in this population, but whether they are cost-effective is unclear. In this systematic review, we will search for cost-effectiveness analyses involving the treatment of pediatric drug-resistant epilepsy with cannabis-based products to inform decision-making by public healthcare payers about reimbursement of such products. We will also search for cost-effectiveness analyses of other pharmacologic treatments for pediatric drug-resistant epilepsy, as well as estimates of healthcare resource use, costs, and utilities, for use in a subsequent cost-utility analysis to address this decision problem. METHODS We will search the published and gray literature for economic evaluations of cannabis-based products and other pharmacologic treatments for pediatric drug-resistant epilepsy, as well as resource utilization and utility studies. Two independent reviewers will screen the title and abstract of each identified record and the full-text version of any study deemed potentially relevant. Study and population characteristics, the incremental cost-effectiveness ratio (ICER), as well as total costs and benefits, will be extracted, and quality will be assessed by use of the Drummond and CHEERS checklists; context-specific issues will also be considered. From model-based cost-utility and cost-effectiveness analyses, we will extract and summarize the model structure, including health states, time horizon, and cycle length. From resource utilization studies, we will extract data about the frequency of resource use (e.g., neurology visits, emergency department visits, admissions to hospital). From utility studies, we will extract the utility for each health state, the source of the preferences (e.g., child, parent, patient, general public), and the method of elicitation. DISCUSSION Drug-resistant epilepsy in children is associated with important costs to the healthcare system, and decision-makers require high-quality evidence on which to base reimbursement decisions. The results of this review will be useful to both decision-makers considering the decision problem of whether to reimburse cannabis-based products through public formularies and to analysts conducting studies in this area. SYSTEMATIC REVIEW REGISTRATION PROSPERO no.: CRD42018099591 .
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Affiliation(s)
- Jesse Elliott
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Canada
| | - Bláthnaid McCoy
- Department of Paediatrics, University of Toronto, Division of Neurology, The Hospital for Sick Children Toronto, Toronto, Ontario Canada
| | - Tammy Clifford
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
| | - Beth K. Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
| | | | - George A. Wells
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
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Elliott J, McCoy B, Clifford T, Wells GA, Coyle D. Economic Evaluation of Stiripentol for Dravet Syndrome: A Cost-Utility Analysis. PHARMACOECONOMICS 2018; 36:1253-1261. [PMID: 29761351 DOI: 10.1007/s40273-018-0669-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Dravet syndrome is a catastrophic form of pediatric treatment-resistant epilepsy with few effective treatment options. Stiripentol is approved for use in Canada for treatment of Dravet syndrome, but the associated long-term costs and benefits have not been well-studied and its cost effectiveness is unclear. OBJECTIVE The aim of this study was to evaluate the cost effectiveness of stiripentol as an adjunctive treatment to clobazam and valproate for treatment of Dravet syndrome from the perspective of the Canadian public healthcare payer. METHODS A cost-utility analysis was performed to estimate the costs and quality-adjusted life-years (QALYs) associated with adjunctive stiripentol treatment compared with clobazam and valproate alone in children with Dravet syndrome. Transition probabilities, drug efficacy, utility weights, and costs were obtained from a review of the literature. Probabilistic analyses were conducted using a Markov model with health states related to seizure frequency. A 10-year horizon was used. The incremental cost per QALY gained (incremental cost-effectiveness ratio [ICER]) for adjunctive use of stiripentol was calculated, and assumptions were explored in scenario analyses. All costs are expressed in 2017 Canadian dollars ($Can). RESULTS Compared with clobazam and valproate alone, the adjunctive use of stiripentol is associated with an ICER of $Can151,310. At a willingness-to-pay threshold of $Can50,000, the probability that stiripentol was the optimal treatment was 5.2%. The cost of stiripentol would need to be reduced by 61.4% for stiripentol to be cost effective. CONCLUSION From the perspective of the Canadian public healthcare payer, stiripentol is not cost effective at its current price at a willingness-to-pay threshold of $Can50,000. Funding stiripentol will be associated with important opportunity costs that bear consideration.
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Affiliation(s)
- Jesse Elliott
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Bláthnaid McCoy
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tammy Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- CADTH, Ottawa, ON, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Wang L, Yarosz S, Aghamoosa H, Grinspan Z, Patel AD. Validating an Algorithm to Identify Patients With Infantile Spasms Using Medical Claims. J Child Neurol 2018; 33:639-641. [PMID: 29862876 DOI: 10.1177/0883073818774960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An infantile spasm is a brief seizure type that is characteristic of West syndrome. Many infants present with infantile spasms between 3-12 months of age. Early diagnosis and proper treatment of patients with infantile spasms can lead to improved clinical outcomes. However, proper identification of these patients using claims data with validation has not been performed. The authors developed and tested several algorithms using claims data. Claims data consisted of using International Classification of Disease (ICD), Current Procedural Terminology (CPT), and prescription codes. Access to the claims database was from an accountable care organization. The algorithm using the specific ICD code for infantile spasms only performed the best with high sensitivity and specificity. This algorithm can be used to perform additional research in claims data for patients with infantile spasms.
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Affiliation(s)
- Ling Wang
- 1 Data Resource Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Shannon Yarosz
- 2 Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Hosain Aghamoosa
- 3 Department of Clinical Pharmacology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Zachary Grinspan
- 4 Division of Health Policy and Economics, Division of Child Neurology, Department of Pediatrics, Weill Cornell Medical College, New York, USA
| | - Anup D Patel
- 2 Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
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18
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Lekoubou A, Bishu KG, Ovbiagele B. Nationwide Healthcare utilization among children with epilepsy in the United States: 2003-2014. Epilepsy Res 2018. [PMID: 29522948 DOI: 10.1016/j.eplepsyres.2018.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Epilepsy is particularly frequent among children, yet updated and nationwide healthcare utilization estimates are scanty in the United States. OBJECTIVE To analyze healthcare utilization among children with epilepsy. METHODS Data on children (≤17-year-old) were extracted from the Medical Expenditure Panel Survey (MEPS) 2003-2014. Epilepsy was identified using the clinical classification code 83. Healthcare utilization (Inpatient admission, outpatient visits, prescription medication including refill, emergency room visits, and home health provider visits) was compared between children with epilepsy and those without epilepsy. A negative binomial model was used to assess the relationship between epilepsy and healthcare utilizations accounting for the influence of extraneous factors. RESULTS In all, a weighted 457,873 children (0.84%) had epilepsy in United States. The unadjusted proportion and the mean annual number of health care service utilization were higher in children with epilepsy compared to those without epilepsy. Children with epilepsy had almost 3.3 more outpatient visits (95% CI: 2.281-4.274), 7.9 more medication prescriptions including refills (95% CI: 6.058-9.662), nearly 0.4 more emergency department visits (95% CI: 0.278-0.438) and nearly 12 more home health provider visits (95% CI: 1.988-21.756) than those without epilepsy. The adjusted marginal effect of epilepsy on inpatient admission was not statistically significant. CONCLUSION unadjusted and adjusted healthcare utilization is considerably higher in children with epilepsy compared to those without epilepsy in the United States with heterogeneity across individual services.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
| | - Kinfe G Bishu
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Section of Health Systems Research and Policy, Medical University of South Carolina, Charleston, SC, USA
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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Examining health service utilization, hospital treatment cost, and mortality of individuals with epilepsy and status epilepticus in New South Wales, Australia 2012-2016. Epilepsy Behav 2018; 79:9-16. [PMID: 29223007 DOI: 10.1016/j.yebeh.2017.11.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 11/20/2022]
Abstract
This study examined the health service utilization and hospital treatment cost of individuals with epilepsy by age group, mortality within 30days, and surgical outcomes for individuals with refractory epilepsy in New South Wales (NSW), Australia. A retrospective examination of linked hospitalization and mortality data for individuals hospitalized with a diagnosis of epilepsy during 2012-2016. Hospitalized incidence rates per 1000 population were calculated, and negative binomial regression was used to examine temporal trends. Mortality within 30days of hospitalization was identified, along with cause of death. There were 44,722 hospitalizations during the five-year period, with a hospitalization rate of 85.6 per 1000 population (95% confidence interval (CI): 84.7-86.4). Total hospital treatment costs were AUD$402.9 million. Children aged ≤17years accounted for 32.0% of hospitalizations. Just over half to two-thirds of hospitalizations for each age group were for a principal diagnosis of epilepsy, with 2976 hospitalizations of individuals for status epilepticus. The overall mean hospital length of stay (LOS) for epilepsy hospitalizations was 5.1days (standard deviation (SD)=9.0). Thirty-day mortality was highest for individuals aged ≥65years (6.7%), and epilepsy was identified as the underlying cause of death for 18.2% of deaths. This research has provided insight into the healthcare utilization profiles of individuals with epilepsy at different ages. Epilepsy hospitalizations constitute a substantial cost to the healthcare system, and better overall management of seizures and comorbid conditions is likely to lead to a reduction in the need for hospitalization.
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Ostendorf AP, Gedela S. Effect of Epilepsy on Families, Communities, and Society. Semin Pediatr Neurol 2017; 24:340-347. [PMID: 29249514 DOI: 10.1016/j.spen.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The effect of epilepsy extends beyond those with the diagnosis and impacts families, communities and society. Caregiver and sibling quality of life is often negatively affected by frequent seizures, comorbid behavioral and sleep disorders and stigma surrounding the diagnosis. Furthermore, the negative effects can be magnified by individual coping styles and resources available to families of those with epilepsy. Beyond the family and immediate caregivers, epilepsy affects local communities by drawing additional resources from education systems. The direct costs of caring for an individual with epilepsy and the indirect costs associated with decreased productivity place financial strain on individuals and health care systems throughout the world. This review details factors affecting family and caregiver quality of life and provides several approaches through which health care providers may address these concerns. Furthermore, we examine the financial effect of epilepsy on society and review emerging strategies to lessen health care use for individuals with epilepsy.
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Affiliation(s)
- Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
| | - Satyanarayana Gedela
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
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Allard J, Shankar R, Henley W, Brown A, McLean B, Jadav M, Parrett M, Laugharne R, Noble AJ, Ridsdale L. Frequency and factors associated with emergency department attendance for people with epilepsy in a rural UK population. Epilepsy Behav 2017; 68:192-195. [PMID: 28219054 DOI: 10.1016/j.yebeh.2017.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/30/2022]
Abstract
Attendance at UK Emergency Departments (EDs) for people with epilepsy (PWE) following a seizure can be unnecessary and costly. The characteristics of PWE attending a UK rural district ED in a 12-month period were examined to foster better understanding of relevant psycho-social factors associated with ED use by conducting cross-sectional interviews using standardized questionnaires. Of the total participants (n=46), approximately one-third of the study cohort attended ED on three or more occasions in the 12-month study period and accounted for 65% of total ED attendances reported. Seizure frequency and lower social deprivation status were associated with increased ED attendance while factors such as knowledge of epilepsy, medication management, and stigma were not. Similarities in frequency of repeat attendees were comparable to a study in urban population but other factors varied considerable. Our findings suggest that regular ED attendees may be appropriate for specific enhanced intervention though consideration needs to be given to the fact that population characteristics may vary across regions.
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Affiliation(s)
- Jon Allard
- Cornwall Partnership NHS Foundation Trust, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, UK; Exeter Medical School, UK.
| | | | | | | | | | | | - Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, UK; Exeter Medical School, UK
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Cost-utility analysis of competing treatment strategies for drug-resistant epilepsy in children with Tuberous Sclerosis Complex. Epilepsy Behav 2016; 63:79-88. [PMID: 27591681 DOI: 10.1016/j.yebeh.2016.07.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/07/2016] [Accepted: 07/24/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The management of drug-resistant epilepsy in children with Tuberous Sclerosis Complex (TSC) is challenging because of the multitude of treatment options, wide range of associated costs, and uncertainty of seizure outcomes. The most cost-effective approach for children whose epilepsy has failed to improve with first-line medical therapy is uncertain. METHODS A review of MEDLINE from 1990 to 2015 was conducted. A cost-utility analysis, from a third-party payer perspective, was performed for children with drug-resistant epilepsy that had failed to improve with 2 antiseizure drugs (ASDs) and that was amenable to resective epilepsy surgery, across a time-horizon of 5years. Four strategies were included: (1) resective epilepsy surgery, (2) vagus nerve stimulator (VNS) implantation, (3) ketogenic diet, and (4) addition of a third ASD (specifically, carbamazepine). The incremental cost per quality-adjusted life year (QALY) gained was analyzed. RESULTS Given a willingness-to-pay (WTP) of $100,000 per QALY, the addition of a third ASD ($6600 for a gain of 4.14 QALYs) was the most cost-effective treatment strategy. In a secondary analysis, if the child whose epilepsy had failed to improve with 3 ASDs, ketogenic diet, addition of a fourth ASD, and resective epilepsy surgery were incrementally cost-effective treatment strategies. Vagus nerve stimulator implantation was more expensive yet less effective than alternative strategies and should not be prioritized. CONCLUSIONS The addition of a third ASD is a universally cost-effective treatment option in the management of children with drug-resistant epilepsy that has failed to improve with 2 ASDs. For children whose epilepsy has failed to improve with 3 ASDs, the most cost-effective treatment depends on the health-care resources available reflected by the WTP.
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Jennum P, Pickering L, Christensen J, Ibsen R, Kjellberg J. Welfare cost of childhood- and adolescent-onset epilepsy: A controlled national study. Epilepsy Behav 2016; 61:72-77. [PMID: 27317897 DOI: 10.1016/j.yebeh.2016.04.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Epilepsy is associated with a significant burden to patients and society. We calculated the factual excess in direct and indirect costs associated with childhood- and adolescent-onset epilepsy. METHODS Using records from the Danish National Patient Registry (1998-2002), we identified 3123 and 5018 patients with epilepsy aged 0-5years and 6-20years at the time of diagnosis, respectively. The two age groups of patients with epilepsy were matched to 6246 and 10,036 control persons without epilepsy, respectively, by gender, age, and geography. The controls were randomly chosen from the Danish Civil Registration System. Welfare costs included outpatient services, inpatient admissions, and emergency room visits based on the Danish National Patient Registry and information from the primary health-care sector based on data from the Danish Ministry of Health. This allowed the total health-care cost of epilepsy to be estimated. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits to outpatient clinics and hospitalizations and costs from primary sectors were based on data obtained from the National Patient Registry. RESULTS Children with epilepsy had higher welfare costs than controls. The highest cost was found one year after diagnosis, with higher costs up to 10years after diagnosis compared with controls. Children aged 0-5years incurred greater health-care costs than those aged 6-20years. CONCLUSION Epilepsy has major socioeconomic consequences for the individual person with epilepsy and for society.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Neurophysiology Clinic, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Line Pickering
- Danish Center for Sleep Medicine, Neurophysiology Clinic, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
| | - Rikke Ibsen
- itracks, Klosterport 4E, 4, Aarhus, Denmark.
| | - Jakob Kjellberg
- Danish National Institute for Local and Regional Government Research, Copenhagen, Denmark.
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Fantaneanu TA, Hurwitz S, van Meurs K, Llewellyn N, O'Laughlin KN, Dworetzky BA. Racial differences in Emergency Department visits for seizures. Seizure 2016; 40:52-6. [PMID: 27344498 DOI: 10.1016/j.seizure.2016.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/20/2016] [Accepted: 06/07/2016] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Seizures are a common reason for visiting the Emergency Department (ED). There is a growing body of literature highlighting disparities in seizure care related to race and ethnicity. Our goal was to identify racial and clinical characteristics of patients presenting to the ED with seizures and to determine factors associated with repeat ED visits for seizure. METHODS This was a retrospective study evaluating patients presenting with seizure as the primary reason for their ED visit between 01/01/2008 and 12/31/2008. Clinical data were collected from the electronic medical record (EMR) and compared between black and white patients and between patients with single and repeat ED seizure visits. Statistically significant variables were introduced in a logistic regression analysis with repeat ED visits as outcome. RESULTS Of 38, 879 ED visits, 559 recorded 'seizure' as the primary reason for the visit. Compared to white patients (N=266), black patients (N=102) were more likely to have non-private insurance (p=0.005), less likely to have evidence of regular ambulatory care (p=0.02) and were more likely to have multiple visits within the calendar year (p=0.005). Black patient visits were more likely to have missed or ran out of antiepileptic drugs (AED) as the precipitant for their ED visit (p<0.001). CONCLUSION Clinical factors differed between black and white patients presenting to the ED for seizure care. Black patients were more likely to have multiple seizure visits to the ED when compared to white patients. This may suggest a disparity in access to care related to race between these two groups.
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Affiliation(s)
| | - Shelley Hurwitz
- Department of Medicine, Brigham and Women's Hospital, United States.
| | | | | | - Kelli N O'Laughlin
- Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, United States.
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Chhabra ST, Masson S, Kaur T, Gupta R, Sharma S, Goyal A, Singh B, Tandon R, Aslam N, Mohan B, Wander GS. Gender bias in cardiovascular healthcare of a tertiary care centre of North India. HEART ASIA 2016; 8:42-5. [PMID: 27326231 DOI: 10.1136/heartasia-2015-010710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To analyse the gender bias in paediatric patients referred for free cardiac treatment as part of School Health Programme at a tertiary care centre in North India. METHODS A total of 537 children were referred for further management of congenital heart disease or rheumatic heart disease. Of these, 519 underwent cardiac intervention, and the data from their records were analysed retrospectively to determine any gender disparity in the utilisation of cardiac surgery. RESULTS Of the 519 children studied, only 195 (37.6%) were girls, while the remaining 324 (62.4%) were boys (male-to-female ratio of 1.66:1, p<0.0001), indicating a large gender divide. Gender bias was found to be prevalent across all the age groups irrespective of the type of cardiac ailment. Moreover, no statistically significant difference was found between the urban and rural populations (male-to-female ratio of 1.64:1 in rural and 1.71:1 in urban populations; p=0.823) in terms of gender disparity. CONCLUSIONS Significant gender discrepancies exist in healthcare-seeking behaviour of patients in North India despite the provision of free cardiac treatment. An equal prevalence of gender bias in urban and rural communities points towards deep-rooted social norms beyond just the economic constraints. Healthcare policies ensuring equal treatment of male and female children should be promulgated to ensure a complete eradication of this social evil.
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Affiliation(s)
- Shibba Takkar Chhabra
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Sarbjit Masson
- Interns in Department of Cardiology at Dayanand Medical College & Hospital , Ludhiana, Punjab , India
| | - Tripat Kaur
- Interns in Department of Cardiology at Dayanand Medical College & Hospital , Ludhiana, Punjab , India
| | - Rajiv Gupta
- Department of Cardiovascular and Thoracic Surgery , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Sarit Sharma
- Department of Community Medicine , Dayanand Medical College & Hospital , Ludhiana, Punjab , India
| | - Abishek Goyal
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Bhupinder Singh
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Rohit Tandon
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Naved Aslam
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Bishav Mohan
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
| | - Gurpreet Singh Wander
- Department of Cardiology , Dayanand Medical College & Hospital-Unit Hero DMC Heart Institute , Ludhiana, Punjab , India
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Puka K, Smith ML, Moineddin R, Snead OC, Widjaja E. The influence of socioeconomic status on health resource utilization in pediatric epilepsy in a universal health insurance system. Epilepsia 2016; 57:455-63. [DOI: 10.1111/epi.13290] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Klajdi Puka
- Department of Psychology; Hospital for Sick Children; Toronto Ontario Canada
| | - Mary Lou Smith
- Department of Psychology; Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; University of Toronto; Toronto Ontario Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine; University of Toronto; Toronto Ontario Canada
| | - O. Carter Snead
- Division of Neurology; Hospital for Sick Children; Toronto Ontario Canada
| | - Elysa Widjaja
- Division of Neurology; Hospital for Sick Children; Toronto Ontario Canada
- Diagnostic Imaging; Hospital for Sick Children; Toronto Ontario Canada
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Hunter RM, Reilly C, Atkinson P, Das KB, Gillberg C, Chin RF, Scott RC, Neville BGR, Morris S. The health, education, and social care costs of school-aged children with active epilepsy: A population-based study. Epilepsia 2015; 56:1056-64. [DOI: 10.1111/epi.13015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Rachael M. Hunter
- Research Department of Primary Care & Population Health; University College London; London United Kingdom
| | - Colin Reilly
- Research Department; Young Epilepsy; Lingfield Surrey United Kingdom
- Gillberg Neuropsychiatry Centre; University of Gothenburg; Gothenburg Sweden
| | - Patricia Atkinson
- Child Development Centre; Crawley Hospital; Crawley West Sussex United Kingdom
| | - Krishna B. Das
- Research Department; Young Epilepsy; Lingfield Surrey United Kingdom
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
- Neurosciences Unit; Institute of Child Health; University College London; London United Kingdom
| | | | - Richard F. Chin
- Muir Maxwell Epilepsy Centre; Edinburgh Neurosciences; The University of Edinburgh; Edinburgh United Kingdom
| | - Rod C. Scott
- Great Ormond Street Hospital for Children NHS Trust; London United Kingdom
- Neurosciences Unit; Institute of Child Health; University College London; London United Kingdom
- College of Medicine; University of Vermont; Burlington Vermont U.S.A
| | - Brian G. R. Neville
- Research Department; Young Epilepsy; Lingfield Surrey United Kingdom
- Neurosciences Unit; Institute of Child Health; University College London; London United Kingdom
| | - Stephen Morris
- Department of Applied Health Research; University College London; London United Kingdom
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Elliott JO, Richardson VE. The biopsychosocial model and quality of life in persons with active epilepsy. Epilepsy Behav 2014; 41:55-65. [PMID: 25305434 DOI: 10.1016/j.yebeh.2014.09.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite a long recognized need in the field of the importance of the psychological and social factors in persons with epilepsy (PWE), the medical community has continued to focus primarily on seizures and their treatment (the biological-biomedical model). From the biopsychosocial perspective, a person's lived experience needs to be incorporated into the understanding of quality of life. While the biopsychosocial model has gained prominence over the years, it has not been studied much in epilepsy. METHODS The study sample included 1720 PWE from the 2003 and the 2005 Canadian Community Health Survey (CCHS). Data were analyzed using set correlation, as it allows for the examination of the relative contribution of sets of independent variables (biological, psychological, and social domains) and a set of dependent variables (quality of life) of interest, defined as self-rated health status, self-rated mental health status, and life satisfaction. RESULTS Results provide strong evidence that the full biopsychosocial model explained a significantly larger amount of variance in quality of life (R(2) = 55.0%) compared with the biological-biomedical model alone (R(2) = 24.8%). When the individual domains of the biopsychosocial model were controlled for, the psychological (R(2) = 24.6%) and social (R(2) = 18.5%) domains still explained a greater amount of the variance in quality of life compared with the biological-biomedical model (R(2) = 14.3%). CONCLUSIONS While seizure freedom will continue to be an important treatment goal in epilepsy, the psychological and social domains are an important consideration for both interventional programs and clinical research designed to improve quality of life in PWE. Better integration of social workers and psychologists into routine care may help address these disparities.
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Affiliation(s)
- John O Elliott
- OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA; The Ohio State University, College of Social Work, Stillman Hall, 1947 College Road, Columbus, OH 43210, USA.
| | - Virginia E Richardson
- The Ohio State University, College of Social Work, Stillman Hall, 1947 College Road, Columbus, OH 43210, USA.
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Biopsychosocial predictors of psychogenic non-epileptic seizures. Epilepsy Res 2014; 108:1543-53. [PMID: 25262500 DOI: 10.1016/j.eplepsyres.2014.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/22/2014] [Accepted: 09/06/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies have identified numerous biological, psychological and social characteristics of persons with psychogenic non-epileptic seizures (PNES) however the strength of many of these factors have not been evaluated to determine which are predictive of the diagnosis compared to those that may only be stereotypes with limited clinical utility. METHOD A retrospective chart review of persons admitted to our epilepsy monitoring unit over a 6-year period was conducted to examine predictors of a video-EEG confirmed PNES diagnosis. RESULTS A total of 689 patients had events leading to a diagnosis, 47% (n=324) with PNES only, 12% (n=84) with PNES & Epilepsy and 41% (n=281) with Epilepsy only. Five biological predictors of a PNES only diagnosis were found; number of years with events (OR=1.10), history of head injury (OR=1.91), asthma (OR=2.94), gastro-esophageal reflux disease (OR=1.72) and pain (OR=2.25). One psychological predictor; anxiety (OR=1.72) and two social predictors; being married (OR=1.81) and history of physical/sexual abuse (OR=3.35). Two significant biological predictors of a PNES & Epilepsy diagnosis were found; migraine (OR=1.83) and gastro-esophageal reflux disease (OR=2.17). CONCLUSIONS Our findings support the importance of considering the biopsychosocial model for the diagnosis and treatment of PNES or PNES with concomitant epilepsy.
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Bresee LC, Knudtson ML, Zhang J, Crowshoe LL, Ahmed SB, Tonelli M, Ghali WA, Quan H, Manns B, Fabreau G, Hemmelgarn BR. Likelihood of coronary angiography among First Nations patients with acute myocardial infarction. CMAJ 2014; 186:E372-80. [PMID: 24847149 DOI: 10.1503/cmaj.131667] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Morbidity due to cardiovascular disease is high among First Nations people. The extent to which this may be related to the likelihood of coronary angiography is unclear. We examined the likelihood of coronary angiography after acute myocardial infarction (MI) among First Nations and non-First Nations patients. METHODS Our study included adults with incident acute MI between 1997 and 2008 in Alberta. We determined the likelihood of angiography among First Nations and non-First Nations patients, adjusted for important confounders, using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. RESULTS Of the 46,764 people with acute MI, 1043 (2.2%) were First Nations. First Nations patients were less likely to receive angiography within 1 day after acute MI (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI] 0.62-0.87). Among First Nations and non-First Nations patients who underwent angiography (64.9%), there was no difference in the likelihood of percutaneous coronary intervention (PCI) (adjusted hazard ratio [HR] 0.92, 95% CI 0.83-1.02) or coronary artery bypass grafting (CABG) (adjusted HR 1.03, 95% CI 0.85-1.25). First Nations people had worse survival if they received medical management alone (adjusted HR 1.38, 95% CI 1.07-1.77) or if they underwent PCI (adjusted HR 1.38, 95% CI 1.06-1.80), whereas survival was similar among First Nations and non-First Nations patients who received CABG. INTERPRETATION First Nations people were less likely to undergo angiography after acute MI and experienced worse long-term survival compared with non-First Nations people. Efforts to improve access to angiography for First Nations people may improve outcomes.
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Affiliation(s)
- Lauren C Bresee
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Merril L Knudtson
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Jianguo Zhang
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Lynden Lindsay Crowshoe
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Sofia B Ahmed
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Marcello Tonelli
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - William A Ghali
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Hude Quan
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Braden Manns
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Gabriel Fabreau
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass
| | - Brenda R Hemmelgarn
- Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
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Abstract
Gender-based discrimination is reported across the spectrum of paediatric healthcare including emergency, inpatient, outpatient and preventive care and is mostly reported from South Asia and China with sporadic reports from Africa and South America. Biases against young girls have been documented even in immunisation percentage, home food allocation, seeking medical care for childhood ailments and percentage of household healthcare expenditures allocated to them. Such gender discrimination in access to medical care is likely to have an influence on the overall health of female children. Over the last five decades, the under-5 sex ratios are worsening in India with declining number of girls. Deliberate parental neglect of girls' essential and life-saving medical care is also an important contributing factor apart from sex-selective abortions to the declining gender ratios. Corrective measures and focused action are needed.
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Affiliation(s)
- Rohan Khera
- Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, , Iowa City, USA
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Fernández IS, Loddenkemper T, Datta A, Kothare S, Riviello JJ, Rotenberg A. Electroencephalography in the pediatric emergency department: when is it most useful? J Child Neurol 2014; 29:475-82. [PMID: 23594820 DOI: 10.1177/0883073813483570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to identify the indications in which electroencephalography in the pediatric emergency department is most useful. We retrospectively reviewed the influence that the results of the emergent electroencephalogram had on the eventual disposition of patients at our pediatric emergency department. Sixty-eight children (mean age, 7.3 years; 32 males) underwent 70 emergent electroencephalograms. Fifty-seven emergent electroencephalograms were performed for the suspicion of ongoing seizures or status epilepticus. Thirteen of the 22 children (59.1%) discharged from the emergency department were sent home mainly based on the results of the emergent electroencephalogram, which prevented an admission. In particular, 11 of 38 children with frequent and recurrent paroxysmal events concerning for seizures and 2 of 19 children with suspected ongoing status epilepticus were discharged after excluding an epileptic disturbance. The emergent electroencephalogram provided meaningful clinical information that influenced disposition, especially in patients with ongoing events in which the clinical picture was clarified by a rapidly acquired electroencephalogram.
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Affiliation(s)
- Iván Sánchez Fernández
- 1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Samuel SM, Nettel-Aguirre A, Soo A, Hemmelgarn B, Tonelli M, Foster B. Avoidable hospitalizations in youth with kidney failure after transfer to or with only adult care. Pediatrics 2014; 133:e993-1000. [PMID: 24664091 DOI: 10.1542/peds.2013-2345] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Hospital admissions for ambulatory care-sensitive conditions (also called avoidable hospitalizations) are a measure of quality and access to outpatient care. We determined if young patients with end-stage renal disease (ESRD) are at increased risk of avoidable hospitalizations. METHODS A national organ failure registry was used to identify patients with ESRD onset at <22 years of age between April 1, 2001, and March 31, 2010, who had received care in an adult care facility after age 15 years. The cohort was linked to the national hospitalizations database to identify avoidable hospitalizations relevant for young patients with ESRD. Patients were followed up until death, loss to follow-up, or study end. Two groups were studied: (1) patients transferred from pediatric to adult care; and (2) patients receiving ESRD care exclusively in adult centers. We determined the association between overall and avoidable hospitalization rates and both age and transfer status by using Poisson regression models. RESULTS Our cohort included 349 patients. Among the 92 (26.4%) patients transferred to adult care during the study period, avoidable hospitalization rates were highest during the period 3 to <4 years after transfer (rate ratio: 3.19 [95% confidence interval: 1.42-7.18]) compared with the last year in pediatric care. Among the 257 (73.6%) patients who received ESRD care exclusively in adult centers, avoidable hospitalization rates increased with age. CONCLUSIONS Among those who were transferred to adult care, avoidable hospitalization rates increased after transfer. Avoidable hospitalization rates increased with age in ESRD patients who received care in adult centers. Young patients with ESRD are at increased risk of avoidable hospitalizations.
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Ali MAS, Elliott RA, Tata LJ. The direct medical costs of epilepsy in children and young people: A population-based study of health resource utilisation. Epilepsy Res 2014; 108:576-86. [DOI: 10.1016/j.eplepsyres.2013.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 11/19/2013] [Accepted: 12/05/2013] [Indexed: 11/25/2022]
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Plummer C, Cook MJ, Anderson I, D'Souza WJ. Australia's seizure divide - indigenous versus non-indigenous seizure hospitalization. Epilepsy Behav 2014; 31:363-8. [PMID: 24210462 DOI: 10.1016/j.yebeh.2013.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 09/26/2013] [Accepted: 09/29/2013] [Indexed: 11/25/2022]
Abstract
Indigenous Australians suffer the highest mortality and morbidity rates of any ethnic minority in the developed world. To determine if the health outcome gulf between indigenous and non-indigenous Australians also applied to seizures, we conducted a retrospective analysis of seizure hospitalization (1998-2004) based on ethnicity (indigenous (I) and non-indigenous (NI)) for four Australian jurisdictions - Northern Territory (NT), Queensland (Qld), South Australia (SA), and Western Australia (WA). Total admissions were converted to age-standardized rates (ASR) and I/NI ASR ratios (I/NIRR) and compared across multiple variables. The summed admission (combined jurisdictions over six years) was 71,185 (I=11,593 and NI=59,592). Seizure hospitalization rate was always higher in the indigenous population (six-year I/NIRR - NT=5.6, Qld=4.0, SA=6.4, and WA=10.9; combined jurisdictions=5.6). Disparity was greatest for ages 40-64years (13.8) and 15-39years (7.0) and for indigenous males (7.4). As socioeconomic status rose, non-indigenous admission rates fell (ASR=1.7 to 1.1), yet indigenous admission rates rose (ASR=7.9 to 14.0). Indigenous emergency to elective admission ratios were higher (I=27 and NI=8), as were readmissions (1.5-2 fold), self-discharge separations (I=9.4% and NI=1.4%), bed days (I/NIRR=5.1), and admissions with an additional diagnosis (I/NIRR=3.3) or procedure (I/NIRR=3.4). Indigenous Australians maintained disproportionately high rates of emergency seizure hospitalization; from 1998 to 2004, the combined jurisdiction rate was more than five times the mean non-indigenous rate. Indigenous males aged 15-64years were overrepresented. Indigenous patients had lengthier admissions but higher self-discharge and readmission rates. The socioeconomic data raise the concern that social disadvantage restricts access to hospital-based seizure care for indigenous patients.
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Affiliation(s)
- Chris Plummer
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, P.O. Box 2900, Fitzroy, Victoria 3065, Australia.
| | - Mark J Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, P.O. Box 2900, Fitzroy, Victoria 3065, Australia
| | - Ian Anderson
- Murrup Barak Melbourne Institute for indigenous Development Population Health, University of Melbourne, Grattan Street, Parkville, Melbourne, Victoria 3052, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, P.O. Box 2900, Fitzroy, Victoria 3065, Australia
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Samuel SM, Palacios-Derflingher L, Tonelli M, Manns B, Crowshoe L, Ahmed SB, Jun M, Saad N, Hemmelgarn BR. Association between First Nations ethnicity and progression to kidney failure by presence and severity of albuminuria. CMAJ 2013; 186:E86-94. [PMID: 24295865 DOI: 10.1503/cmaj.130776] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Despite a low prevalence of chronic kidney disease (estimated glomerular filtration rate [GFR]<60 mL/min per 1.73 m2), First Nations people have high rates of kidney failure requiring chronic dialysis or kidney transplantation. We sought to examine whether the presence and severity of albuminuria contributes to the progression of chronic kidney disease to kidney failure among First Nations people. METHODS We identified all adult residents of Alberta (age≥18 yr) for whom an outpatient serum creatinine measurement was available from May 1, 2002, to Mar. 31, 2008. We determined albuminuria using urine dipsticks and categorized results as normal (i.e., no albuminuria), mild, heavy or unmeasured. Our primary outcome was progression to kidney failure (defined as the need for chronic dialysis or kidney transplantation, or a sustained doubling of serum creatinine levels). We calculated rates of progression to kidney failure by First Nations status, by estimated GFR and by albuminuria category. We determined the relative hazard of progression to kidney failure for First Nations compared with non-First Nations participants by level of albuminuria and estimated GFR. RESULTS Of the 1 816 824 participants we identified, 48 669 (2.7%) were First Nations. First Nations people were less likely to have normal albuminuria compared with non-First Nations people (38.7% v. 56.4%). Rates of progression to kidney failure were consistently 2- to 3-fold higher among First Nations people than among non-First Nations people, across all levels of albuminuria and estimated GFRs. Compared with non-First Nations people, First Nations people with an estimated GFR of 15.0-29.9 mL/min per 1.73 m2 had the highest risk of progression to kidney failure, with similar hazard ratios for those with normal and heavy albuminuria. INTERPRETATION Albuminuria confers a similar risk of progression to kidney failure for First Nations and non-First Nations people.
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Franchi C, Giussani G, Messina P, Montesano M, Romi S, Nobili A, Fortino I, Bortolotti A, Merlino L, Beghi E. Validation of healthcare administrative data for the diagnosis of epilepsy. J Epidemiol Community Health 2013; 67:1019-24. [PMID: 24022813 DOI: 10.1136/jech-2013-202528] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Administrative databases have become an important tool to monitor diseases. Patients with epilepsy could be traced using disease-specific codes and prescriptions, but formal validation is required to obtain an accurate case definition. The aim of the study was to correlate administrative data on epilepsy with an independent source of patients with epilepsy in a district of Lombardy, Northern Italy, from 2000 to 2008. METHODS Data of nearly 320 600 inhabitants in the district of Lecco collected from the Drug Administrative Database of the Lombardy Region were analysed. Among them were included patients who fulfilled the International Classification of Diseases 9 (ICD-9) codes and/or the disease-specific exemption code for epilepsy and those who had at least one EEG record and took antiepileptic drugs (AEDs) as monotherapy or in variable combinations. To ascertain epilepsy cases, 11 general practitioners (GPs) with 15 728 affiliates were contacted. Multiple versions of the diagnostic algorithm were developed using different logistic regression models and all combinations of the four independent variables. RESULTS Among the GP affiliates, 71 (4.5/1000) had a gold standard diagnosis of epilepsy. The best and most conservative algorithm included EEG and selected treatment schedules and identified 61/71 patients with epilepsy (sensitivity 85.9%, CI 76.0% to 92.2%) and 15 623/15 657 patients without epilepsy (specificity 99.8%,CI 99.7% to 99.8%). The positive and negative predictive values were 64.2% and 99.9%. Sensitivity (86.7%) and the positive predictive value (68.4%) increased only slightly when patients with single seizures were included. CONCLUSIONS A diagnostic algorithm including EEG and selected treatment schedules is only moderately sensitive for the detection of epilepsy and seizures. These findings apply only to the Northern Italian scenario.
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Affiliation(s)
- C Franchi
- Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', , Milano, Italy
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Deved V, Jette N, Quan H, Tonelli M, Manns B, Soo A, Barnabe C, Hemmelgarn BR. Quality of care for First Nations and non-First Nations People with diabetes. Clin J Am Soc Nephrol 2013; 8:1188-94. [PMID: 23449766 PMCID: PMC3700698 DOI: 10.2215/cjn.10461012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/28/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Compared with non-First Nations, First Nations People with diabetes experience higher rates of kidney failure and death, which may be related to disparities in care. This study examined First Nations and non-First Nations People with diabetes for differences in quality indicators and their association with kidney failure and death. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Adults with diabetes and an outpatient creatinine in Alberta from 2005 to 2008 were identified. Logistic regression was used to determine the likelihood of process of care indicators (measurement of urine albumin/creatinine ratio [ACR], LDL, and hemoglobin A1C [A1C]) and surrogate outcome indicators (achievement of LDL and A1C targets). Cox regression was used to determine the association between lack of achievement of indicator targets and each of kidney failure and death. RESULTS This study identified 140,709 non-First Nations and 6574 First Nations People with diabetes. There was a significant interaction between First Nations status and CKD for the outcomes (P<0.01); therefore, results are stratified by CKD. Among participants without CKD, First Nations People were less likely to receive process of care indicators and achieve target A1C compared with non-First Nations People. For those with CKD, First Nations People were as likely to receive these indicators (other than LDL) and achieve LDL and A1C targets. Lack of LDL and A1C assessment and achievement of targets were associated with increased risk of kidney failure and death similarly for both groups. CONCLUSIONS Compared with non-First Nations, First Nations People with diabetes but without CKD experience disparities in assessment of quality indicators and achievement of A1C target.
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Affiliation(s)
- Vinay Deved
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and
| | - Nathalie Jette
- Departments of Clinical Neurosciences
- Community Health Sciences, and
| | | | - Marcello Tonelli
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and
| | - Braden Manns
- Community Health Sciences, and
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Cheryl Barnabe
- Community Health Sciences, and
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Community Health Sciences, and
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - for the Alberta Kidney Disease Network
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and
- Departments of Clinical Neurosciences
- Community Health Sciences, and
- Medicine, University of Calgary, Calgary, Alberta, Canada
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Avetisyan R, Cabral H, Montouris G, Jarrett K, Shapiro GD, Berlowitz DR, Kase CS, Kazis LE. Evaluating racial/ethnic variations in outpatient epilepsy care. Epilepsy Behav 2013; 27:95-101. [PMID: 23399943 DOI: 10.1016/j.yebeh.2012.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/07/2012] [Accepted: 12/08/2012] [Indexed: 11/28/2022]
Abstract
This study evaluated the quality of epilepsy care in an ambulatory population of a major medical center and determined if there were any racial/ethnic variations. The well-established 'Quality Indicators in Epilepsy Treatment (QUIET)' study dataset was used. Medical record, phone interview, and mail-out survey data of 311 patients with epilepsy were linked and analyzed. Evaluation of care from provider and patient perspectives was performed. Overall, the patients with epilepsy received 40.9% of QI recommended care. The black patients were more likely to receive 50% or more QI recommended care compared with non-Hispanic whites (odds ratio [OR]=2.16, 95% confidence interval [CI] 1.09-4.27). Black patients scored significantly worse than non-Hispanic whites for two patient-reported measures--perceived racial/ethnic disparities (OR=3.14, 95% CI 1.15-8.53) and difficulties getting follow-up appointments (OR=3.37, 95% CI 1.55-7.32). The results indicate the need to evaluate both provider- and patient-centered measures in quality-of-care studies in disparities research.
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Affiliation(s)
- Ruzan Avetisyan
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Jette N, Choi H, Wiebe S. Applying evidence to patient care: from population health to individual patient values. Epilepsy Behav 2013; 26:234-40. [PMID: 23041288 DOI: 10.1016/j.yebeh.2012.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 08/11/2012] [Indexed: 11/18/2022]
Abstract
What are the health status and health needs of people with epilepsy? How do clinicians and patients choose between alternative interventions for the same condition? Are health interventions used effectively in the community, and do they improve health? How can we translate findings from regulatory clinical trials to the real world? These and similar questions are the subject of applied translational research. This evolving and broad-ranging area of research involves the application of basic sciences such as epidemiology, biostatistics, economics, and behavioral science to the assessment of health, health interventions, and outcomes. However, despite its palpable importance, applied translational research remains underfunded and underutilized. Using their own innovative research as a prototype, two young and promising investigators provide insights not only into the enormous potential but also the gaps and hurdles of two specific areas of applied translational research, i.e., clinical decision analysis and health services research. The message is clear that if we are to understand and improve the health of people with epilepsy in clinics, hospitals, and communities, we must substantially increase research capacity to address the many gaps that thwart our progress in applied research in epilepsy.
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Affiliation(s)
- Nathalie Jette
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
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Helmers SL, Duh MS, Guérin A, Sarda SP, Samuelson TM, Bunker MT, Olin BD, Jackson SD, Faught E. Clinical outcomes, quality of life, and costs associated with implantation of vagus nerve stimulation therapy in pediatric patients with drug-resistant epilepsy. Eur J Paediatr Neurol 2012; 16:449-58. [PMID: 22261080 DOI: 10.1016/j.ejpn.2012.01.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/30/2011] [Accepted: 01/01/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND VNS (Vagus Nerve Stimulation Therapy) is approved in the USA to treat refractory epilepsy as adjunctive to antiepileptic drugs (AEDs) in patients ≥12 years with complex partial seizures. AIMS To evaluate clinical outcomes, quality-adjusted life years (QALY), and costs associated with VNS in pediatric patients with drug-resistant epilepsy in a real-world setting. METHODS A retrospective analysis was conducted using Medicaid data (USA). Patients had ≥1 neurologist visits with epilepsy diagnosis (ICD-9 345.xx, 780.3x), ≥1 procedure claims for VNS implantation, ≥1 AEDs, ≥6-months of Pre- and Post-VNS continuous enrollment. Pre-VNS period was 6-months and Post-VNS period extended from implantation until device removal, death, Medicaid disenrollment, or study end (up to 3 years). Incidence rate ratios (IRR) and costs ($2010) were estimated. QALYs were estimated using number of seizure-related events. RESULTS For patients 1-11 years old (N = 238), hospitalizations and emergency room visits were reduced Post-VNS vs. Pre-VNS (adjusted IRR = 0.73 [95% CI: 0.61-0.88] and 0.74 [95% CI: 0.65-0.83], respectively). Average total healthcare costs were lower Post-VNS vs. Pre-VNS ($18,437 vs. $18,839 quarterly [adjusted p = 0.052]). For patients 12-17 years old (N = 207), hospitalizations and status epilepticus events were reduced Post-VNS vs. Pre-VNS (adjusted IRR = 0.43 [95% CI: 0.34-0.54] and 0.25 [95% CI: 0.16-0.39], respectively). Average total healthcare costs were lower Post-VNS vs. Pre-VNS period ($14,546 vs. $19,695 quarterly [adjusted p = 0.002]). Lifetime QALY gain after VNS was 5.96 (patients 1-11 years) and 4.82 years (patients 12-17 years). CONCLUSIONS VNS in pediatric patients is associated with decreased resource use and epilepsy-related events, cost savings, and QALY gain.
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Affiliation(s)
- Sandra L Helmers
- Emory University School of Medicine, Atlanta, GA 30322, United States.
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Noble AJ, Goldstein LH, Seed P, Glucksman E, Ridsdale L. Characteristics of people with epilepsy who attend emergency departments: Prospective study of metropolitan hospital attendees. Epilepsia 2012; 53:1820-8. [DOI: 10.1111/j.1528-1167.2012.03586.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Elliott JO, Mares AS. Gender differences in quality of life among Canadian adults with epilepsy. Epilepsy Res 2012; 100:42-8. [PMID: 22309947 DOI: 10.1016/j.eplepsyres.2012.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 01/02/2012] [Accepted: 01/15/2012] [Indexed: 11/19/2022]
Abstract
The clinical literature suggests epilepsy may impact quality of life in males and females differently. Previous research on gender issues has focused primarily on biological-biomedical factors over psychological and social factors. In this study we compare subjective and objective quality of life in adult persons with epilepsy to persons without epilepsy by gender using the biopsychosocial model in the Canadian Community Health Survey (CCHS), a large epidemiological survey that covers 98% of the Canadian population. Logistic regression analyses were conducted using self-rated health status and the Health Utility Index(®) 3 (HUI3) as the outcomes. Quality of life was significantly moderated after controlling for the biological-biomedical variables in all analyses except the HUI3. Males with epilepsy were more likely to have HUI3 scores of 0.70 or greater than males without epilepsy (OR = 1.61, 95%CI 1.32-1.96). For males with epilepsy the HUI3 was further moderated, but remained significantly better in the final model that controlled for biological, psychological and social factors (OR = 1.43, 95%CI 1.17-1.76). Our findings provide support for treatment approaches that focus on the whole person. Such approaches should take into account gender differences when examining objective quality of life.
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Affiliation(s)
- John O Elliott
- Department of Medical Education, OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, United States.
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Reid AY, Metcalfe A, Patten SB, Wiebe S, Macrodimitris S, Jetté N. Epilepsy is associated with unmet health care needs compared to the general population despite higher health resource utilization--a Canadian population-based study. Epilepsia 2012; 53:291-300. [PMID: 22221191 DOI: 10.1111/j.1528-1167.2011.03353.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE (1) To determine whether health resource utilization (HRU) and unmet health care needs differ for individuals with epilepsy compared to the general population or to those with another chronic condition (asthma, diabetes, migraine); and (2) to assess the association among epilepsy status, sociodemographic variables and HRU. METHODS Data on HRU were assessed using the 2001-2005 Canadian Community Health Surveys, a nationally representative population-based survey. Weighted estimates of association were produced as adjusted odds ratio with 95% confidence intervals, and logistic regression was used to explore the association between sociodemographic variables and HRU in those with epilepsy. All data on disease status, HRU, and unmet health care needs were self-reported. KEY FINDINGS Individuals with epilepsy had the highest rate of hospitalizations and the highest mean number of consultations with physicians. Despite higher rates of consultation with psychologists and social workers compared to the general population, those with epilepsy were significantly more likely to say they had unmet mental health care needs. People with epilepsy were also less likely to use dental services compared to the general population. Epilepsy was a significant predictor of HRU in logistic regression models. SIGNIFICANCE Given the prevalence of psychiatric comorbidities in those with epilepsy, it is concerning that this group perceives unmet mental health care needs. It is also troublesome that there was decreased utilization of dental health care resources in those with epilepsy considering that these patients are more likely to have poor oral health. Although individuals with epilepsy use more health care services than the general population, this increase appears to be insufficient to address their health care needs.
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Affiliation(s)
- Aylin Y Reid
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Jennum P, Gyllenborg J, Kjellberg J. The social and economic consequences of epilepsy: A controlled national study. Epilepsia 2011; 52:949-56. [DOI: 10.1111/j.1528-1167.2010.02946.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Beecham J, Snell T, Perkins M, Knapp M. Health and social care costs for young adults with epilepsy in the UK. HEALTH & SOCIAL CARE IN THE COMMUNITY 2010; 18:465-473. [PMID: 20491967 DOI: 10.1111/j.1365-2524.2010.00919.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Maintaining contact with services will help improve clinical and social outcomes as children with epilepsy move into their adult lives. This study has collated evidence on the extent to which young adults with epilepsy are supported by health and social care services posttransition, and the costs of such support. UK prevalence and service use data were taken from policy and research literature, as well as national data sets and reports. Costs were attached to these data to arrive at agency and overall total costs. There are approximately 42,000 young adults (18-25 years) with epilepsy costing the UK health and social care budgets 715.3 pound million per annum, on average 17,000 found per young adult with epilepsy. A further 61 pound million falls to the social security budget. Most young adults with epilepsy will rarely use these services, but those with additional health needs have high and often long-term support needs, including supported accommodation and personal care. Current resources used by these young adults are summarised but deficits in service availability can mean long waiting times and sub-optimal treatment. Young adults also want more support to help them take advantage of education and employment opportunities and more information about managing the impacts of epilepsy on their lives. Improving services will cost money, but has the potential to lead to better outcomes for young adults.
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Affiliation(s)
- Jennifer Beecham
- Personal Social Services Research Unit, University of Kent, Canterbury, UK.
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Kurth T, Lewis BE, Walker AM. Health care resource utilization in patients with active epilepsy. Epilepsia 2009; 51:874-82. [DOI: 10.1111/j.1528-1167.2009.02404.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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