Abstracts

RATIONALE: Some patients receive at least a part of their epilepsy care from a primary care physician (PCP). We analyzed some aspects of the quality of that care.
METHODS: 208 patients seen in a university Family Practice Clinic between 1992 and 1997 had a diagnosis of epilepsy. 118 charts could be found and were analyzed further.
RESULTS: 116 patents had one non-specific diagnosis code and the other two had a second non-specific code. No patients had their epilepsy diagnosed according to the International Classification. In one case there was evidence in the chart to contradict the diagnosis of epilepsy and the family practioner stated that he did not agree with the diagnosis but he nevertheless continued to diagnose the patient with epilepsy and to treat the patient with AED. In five other cases there was documentation which called the diagnosis into question. AEDs inappropriate to the described seizure type were used, no changes in AED regimen were made in response to recurrent seizures and signs of toxicity were not further evaluated or acted upon.
There were 50 men and 68 women in the study population. Age distributions did not differ statistically significantly. Ages ranged from pediatric to geriatric. The charts of women (35%) were slightly but not significantly more likely than those of men (26%) to contain information which called the diagnosis of epilepsy into question.
CONCLUSIONS: In spite of efforts to defer epilepsy care to specialists, patients continue to go to their PCP for some of their epilepsy care. PCPs should have exposure to epilepsy care during training and after so that they have the tools and confidence to manage common problems rigorously and to re-evaluate and possibly alter old diagnoses in the light of new information. The quality of epilepsy care of women seems to be slightly more affected by the delivery of epilepsy care by PCP.
Disclosure: Other - none