Abstracts

Rationale: Access to expert care is a significant determinant of improved health in patients with epilepsy. However, availability of neurological services is limited by a deficit of neurologists, which is growing with an aging population and implementation of the Affordable Care Act. Nurse practitioners (NPs) are increasingly employed in epilepsy care teams as a means to increase neurological outpatient services, yet the health outcomes associated with this multidisciplinary approach are poorly understood. Methods: We performed a retrospective observational cohort study of adult patients with epilepsy, identified by ICD-9 code and use of antiepileptic drug or seizure within the last year, who completed a new patient visit with an epilepsy specialist at our center in 2014. During 2014, a physician-only care model and a physician-NP care model were both employed in our clinic; a particular clinic session was planned as either: 1) the physician working alone without an NP (physician-only model), or 2) the physician working with an NP during which both providers would see each new patient (physician-NP model). Patients were included who had at least one follow-up appointment within one year and data from all care encounters within that year was abstracted from the electronic medical record. Adherence to the American Academy of Neurology 2014 epilepsy quality measures and clinical outcomes, including seizure improvement (>50% seizure reduction between the first and last visits) and unplanned presentations to the hospital for seizure, were measured. Chi-squared and Fisher exact tests were performed for comparisons between care models. Results: Of the 61 patients reviewed, 24 (39%) were seen as new patients in the physician-NP model. Both care models exceeded 95% adherence for the measures of documentation of seizure frequency, offering an intervention to reduce seizures, documenting or ordering testing for seizure etiology, and screening for behavioral health disorders. Adherence was lower for offering an intervention for antiepileptic drug side effects (physician-NP 69% vs. physician-only 71%, p = 1.0). While no significant differences between care models were observed in adherence to the epilepsy quality measures, there was a trend towards improved adherence by the physician-NP model to the measures of personalized safety counseling (88% vs. 68%, p = 0.13) and counseling women of childbearing potential (100% vs. 62%, p = 0.13). No differences between care models were seen in the clinical outcomes of seizure improvement (50% vs. 56%, p = 0.66) and unplanned presentations to the hospital for seizure (25% vs. 16%, p = 0.40). We are currently analyzing an additional 120 patients and completing analysis of new patient appointment availability within each care model. Conclusions: At our epilepsy center, employment of a physician-NP model to expand availability of specialist care to new patients provides high quality care that is comparable to the traditional physician-only model. Funding: Epilepsy Foundation Research Training Fellowship for Clinicians 2015-2016