Professionals in Epilepsy Care Symposium: Access to Epilepsy Care

Across the Spectrum December 7, 2013 Janelle L. Wagner, PhD

Medical University of South Carolina

American Epilepsy Society | Annual Meeting

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Professionals in Epilepsy Care Symposium: Access to Epilepsy Care

Across the Spectrum December 7, 2013 Janelle L. Wagner, PhD

Medical University of South Carolina

American Epilepsy Society | Annual Meeting

Disclosure

Name of Commercial Interest

None

American Epilepsy Society | 2013 Annual Meeting

Type of Financial Relationship

Learning Objectives

•Recognize and explicitly address cultural barriers to managing care for persons with epilepsy

•Provide care for children and youth with epilepsy by utilizing medical home and telemedicine

•Collaborate with patient in developing, utilizing, and maintaining self-management skills for psychiatric comorbidities and psychosocial challenges or recognize the need to refer patient to mental health professional

American Epilepsy Society | 2013 Annual Meeting

Institute of Medicine Report

•Charge to the epilepsy community to improve: •Access to care •Prevention and treatment of epilepsy •Prevention and treatment of the comorbidities of epilepsy , quality of life and health related outcomes

•http://www.iom.edu/Reports/2012/Epilepsy-Across-the-Spectrum.aspx. Epilepsy across the spectrum: promoting health and understanding. Institute of Medicine of the National Academies; 2012.

American Epilepsy Society | 2013 Annual Meeting

Access to Care: IOM Report

•Low SES •> ED visits and > hospitalization rates •50% less likely to take AEDs

•Racial and ethnic minorities •AA more likely to use ED for epilepsy care & less likely to have surgery •AA and Hispanics had lower rates of epilepsy visits to specialists

•Children •Greater difficulties for children with Medicaid to access neurologists •Wait time of 53 days to see a child neurologist

•Challenges to improving access to care •Timely, adequate care •By the appropriate health care and human service providers

American Epilepsy Society | 2013 Annual Meeting

Comorbidities

• Up to 50% of persons with epilepsy have psychiatric, developmental, and/or cognitive comorbidities.

•(Jensen, Epilepsia. 2011;52, 1-6)

•Depression is the most frequent comorbidity. •(Kanner et al., Epilepsy & Beh. 2012; 24, 156-168)

•Persons with epilepsy and a psychiatric comorbidity report poorer quality of life, experience more AED side effects and more seizures, and report more unmet physical and mental health care needs.

•(Baca et al., Pediatrics. 2011; 128, e1532-e1543; Kanner et al., Epilepsy & Beh. 2012; 24, 156-168; Kanner et al., Epilepsia. 2012; 53, 1104-1108; Russ et al., Pediatrics. 2012; 129, 256-264; )

American Epilepsy Society | 2013 Annual Meeting

American Epilepsy Society | 2013 Annual Meeting

EPILEPSY AS A SPECTRUM DISORDER

Case Example

•Adolescent female •Focal epilepsy, medically uncontrolled •Symptoms of depression •Medicaid •Lives in western, rural Colorado •Mother speaks solely Spanish •Mother can't bring her to hospital for EMU evaluation

•Distance, weather •No child care for other children •Wages lost

Access to Epilepsy Care Across the Spectrum

•Epidemiologic Research- Dr. David Thurman

•Cultural Considerations- Dr. Lisa Andermann

•Advocacy- Phil Gattone

•Pediatric Care- Dr. Jan Buelow

•Medical Home and Telemedicine- Linda Fletcher

•Adult Mental Health- Dr. Nancy Thompson