Abstracts

Rationale: Epilepsy affects approximately 70,000 people in Ontario, where an estimated 21,000 people, both adults and children, suffer from medically refractory epilepsy. Specialized care for paediatric and adult populations is provided by a select number of hospitals with some having the ability to evaluate surgical candidacy. The Ontario Health Technology Advisory Committee (OHTAC) in 2007, requested an evaluation of the diagnostic process and modalities utilized to identify epilepsy surgical candidates at The Hospital for Sick Children (SickKids) in Toronto. Findings from the study, presented to OHTAC in 2011, identified that a limited number of potential candidates were being referred for Pediatric epilepsy surgical assessment (6 % annual referral rate) and that wait times for surgery from time of referral was 1.2 years. OHTAC commissioned a working group to provide further information concerning the current provision of care and subsequently, an Expert Panel to develop a strategy for the provision of epilepsy care.Methods: Two multidisciplinary teams consisting of clinicians (both pediatric and adult care), hospital administrators, health economists, academics, ethicists and government representatives were formed to make recommendations on a provincial strategy for epilepsy care and access to surgical assessment and interventions. Data were gathered on incidence and prevalence of epilepsy in the province, an economic analysis, and barriers to epilepsy care. From March 2011 to January 2013, a series of iterative meetings and presentations to OHTAC and Ministry of Health & Long-Term Care were held to communicate the findings of the Expert Panels.Results: The Expert Panels proposed to expand the resources at current regional centres with the creation of surgical centres of excellence and district epilepsy care centres. System wide issues related to epilepsy care such as attitudes and awareness; resources and capacity; coordination and standardization; and geographical distribution were identified. In 2012, OHTAC, through its parent body, Health Quality Ontario, made a formal recommendation to the government to utilize the findings of the Expert Panel to improve access to diagnostic testing for surgical candidacy for epilepsy surgery (www.hqontario.ca). In 2013, funding was provided by the government to expand epilepsy monitoring capacity across the province. A task force was created to implement the panels reports, the goal being to provide comprehensive, systematic evidence-based medical and surgical epilepsy care for all those in Ontario afflicted with this disorder.Conclusions: We have demonstrated an approach to the development of comprehensive epilepsy care across the life span. A united, multidisciplinary approach was required with the development of an essential unique working partnership between government, academia and clinicians along with support from patient advocacy groups. This first of a kind government sponsored strategy for epilepsy care can be used as an example for other countries and jurisdictions to reform epilepsy care.