Access to Neurology Healthcare Professionals in the United States Among Medicaid Patients with Epilepsy (P6-9.009)

Abstract

<h3>Objective:</h3> Examine provider access restrictions among adults with epilepsy enrolled under Medicaid. <h3>Background:</h3> Patients with epilepsy may not receive the antiseizure medications (ASMs) they need due to limited access to neurology healthcare professionals (HCPs). <h3>Design/Methods:</h3> Adults with ≥1 epilepsy diagnosis or ≥2 diagnoses for unspecified convulsions on different days (within 12 months) were identified in the all-payer claims database (January 1, 2014–May 31, 2021). Medicaid patients prescribed ≥1 ASM on/after initial diagnosis (date of first ASM prescription=index date) with continuous medical and pharmacy benefits for ≥12 months pre-and post-index date were included. Demographic characteristics at index and clinical characteristics within the 12-months pre-index were captured. Proximity to a neurology HCP for epilepsy-related care (defined as availability of a neurologist/neuropsychiatrist within the patient’s zip-3 location), and patient utilization of neurology HCPs during 12-months post-index were assessed. <h3>Results:</h3> 24,722 patients (mean age 43.3 years; 62.4% female) met all selection criteria. Most patients were white (80.4%), non-Hispanic (67.7%), and resided in an urban area (91.1%). The most common comorbidities (≥20% of patients) were unspecified convulsions (48.9%), anxiety (34.5%), and depression (28.8%). Most patients were prescribed index ASMs by non-neurology HCPs; 25.0% received their index ASM prescription from a neurology HCP. Nationwide, 92.2% of patients (60.2% rural, 95.4% urban) utilized a neurology HCP to access ASM treatment during index or follow-up; however, only 28.7% (12.6% rural, 30.3% urban) lived within proximity of a neurology HCP. <h3>Conclusions:</h3> Most Medicaid patients with epilepsy had low access to neurology HCPs in proximity to home and were prescribed their first ASM by a non-neurology HCP. The majority of patients utilized neurology HCPs within 12 months of index, showing a high need for specialist care. <b>Disclosure:</b> Mr. Peeples has received personal compensation for serving as an employee of UCB. Mr. Dieyi has received personal compensation for serving as an employee of STATinMED. Ms. Maughn has received personal compensation for serving as an employee of STATinMED. Ms. Achter has received personal compensation for serving as an employee of STATinMED.