Authors :
Presenting Author: Anthony Di Caro, D.O. – Cohen Children's Medical Center
Shefali Karkare, M.D. – Cohen Children's Medical Center
Avy Ronay, M.D. – Cohen Children's Medical Center
Rationale:
This quality improvement initiative aims to increase the rate of adolescent/young adult females with epilepsy on an antiepileptic drug (AED) regimen who are actively ordered for folic acid supplementation in an outpatient setting. Our population is adolescent/young adult females between 12 to 27 years old who are on an anti-seizure medication and seen primarily by the pediatric neurology providers affiliated with Cohen Children’s Medical Center.
Methods:
We designed a quality improvement project with the primary intervention being an education session for providers focused on the importance of folic acid supplementation in this patient cohort and utilization of our electronic medical record (EMR) to start and maintain active prescriptions for folic acid supplementation. Secondary interventions included posting fliers in our office space visible to providers during their patient encounters and adding a new shortcut in our EMR to help facilitate ordering prescriptions. Additional PDSA cycles will be considered every 3 months for a total of 3 cycles depending on results. We will compare active folic acid orders within our EMR for these patients before and after these interventions. Further subgroup analysis will be performed targeting whether the following data points have any significant relationship to the likelihood of a patient having an active folic acid prescription ordered: number of antiseizure medications prescribed, in-person vs. telehealth appointment for most recent follow up, patient’s race/ethnicity, and patients with a primary language other than English.Results:
In 2024 our combined practices saw 615 unique adolescent/young adult female patients with epilepsy, of them 70 patients had an active folic acid prescription order (11%). In the first 6 months of 2025, we saw 928 unique adolescent/young adult female patients with epilepsy (this increase likely due to the recent hire of 2 new epilepsy providers), of them 138 had an active folic acid (15%). Our interventions were implemented on 7/1/2025, and since then approximately 25% of the adolescent female patients with epilepsy that we have seen had an active order for folic acid placed in their chart. Conclusions:
Interventions that aim to educate providers on the importance of folic acid supplementation for adolescent female patients with epilepsy and remind providers during patient encounters to both discuss and prescribe supplementation have been shown to increase supplementation rates. Our project remains in the early stages of implementation, however we have already seen modest improvement in our prescription rates for folic acid. Our goal is to increase our prescription rates to 75% of all female adolescent/young adult patients aged 12-27 years old who follow with our practices, which will likely involve at minimum two additional PDSA cycles at least 3 months apart. One limitation of this project is patient adherence to supplementation, however future cycles/projects we pursue will shift towards medication compliance once prescription rates have satisfactorily increased. Funding: No funding was received in support of this abstract.