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

Abstract

PurposeTo review clinical outcomes of a single face-to-face review of people with epilepsy (PWE) not under shared care, and any recommendations following a notes review of non-attendees and those under shared care, by a GP with Special Interest in epilepsy (GPwSIe). MethodOne hundred and eighty one PWE, not under shared care were invited for a review. In addition, fifty six people under shared care had a notes review. Interventional outcomes were reviewed after 12 months. ResultsThere had been ten deaths (all non-attributable to epilepsy), and six people had left the area, leaving 221 people who completed the audit. Fifty one percent attended for review, and were more likely to be in documented remission (p = 0.01). The frequency of annual GP epilepsy reviews in the following year did not rise significantly. There was a significant rise in vitamin D prescriptions (p < 0.001). Thirty seven DEXA scans were arranged, 76% were abnormal. There was reluctance by patients to withdraw medication, change multi dose, or subtherapeutic anti-seizure medication (ASM) regimes, even in the context of long-term seizure remission or inadequate seizure control. Three people achieved remission from changes made to ASM as a result of the review. ConclusionReview of PWE in primary care remains poor. Attitudes from both GPs and PWE to their condition needs evaluation in order to plan future care. Bone health is an issue easily addressed in primary care and should be promoted through education or the re-introduction of a specific QOF (Quality and Outcomes Framework) target. Guidance on bone health for ASM needs clarification. This study adds to the evidence of the effectiveness of a GPwSIe.