Abstracts

RATIONALE: It is difficult to measure quality of care for children attending hospital clinics with suspected epilepsy. Care can be delivered by general pediatricians in their mixed general clinics, or by pediatricians or pediatric neurologists in designated pediatric seizure clinics. Can one system be shown superior to the other? METHODS: An audit instrument for assessing the quality of a patient's first hospital clinic consultation for suspected epilepsy has been developed by the British Paediatric Neurology Association (Appleton et al., 1998. Seizure :7;489-495). We used this instrument to search for differences in quality of care between these two systems of secondary pediatric care delivery. The instrument assesses care by comparing documentation of the consultation in the patients medical records to a pre-determined standard, under various categories: history and exam, investigations, treatment and communication. The records of 49 seizure clinic children were compared to 42 pediatric clinic children, each referred by a general family physisian for suspected epilepsy. RESULTS:There was no difference in the age or sex distribution between the two clinics. Children attending the seizure clinic were more likely to have seizure semiology (100% vs 72%) and type (100% vs 82%), neuro-development (82% vs 50%) and school performance (86% vs 42%), physical examination (91% vs 84%), and advice on patient support groups (6% vs nil) recorded. They were more likely to have a diagnosis of non-epileptic, uncertain episodes, a localisation-related epilepsy and benign partial epilepsy than those attending the general paediatric clinic, who were more often given a diagnosis of generalised or unspecified epilepsy. CONCLUSIONS: Systematic review of patient medical records is just one way of assessing quality of care. The seizure clinic performed better than the general pediatric clinic. Comparison of other standard criteria e.g. specific diagnosis and reasons for drug adjustments by 1 year after first visit is underway.