Authors :
Presenting Author: Laura Bernstein, PhD – Dartmouth College
Lisa Feely, MS – Dartmouth College
Trina Dawson, BA – Dartmouth Health
Sarah Kaden, BA – Dartmouth Health
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth Health
Rationale:
HOme Based Self-management and COgnitive Training CHanges Lives (HOBSCOTCH) is an evidence-based cognitive behavioral intervention shown to improve quality of life and cognition for people with epilepsy (PWE). The HOBSCOTCH Institute (HI) provides infrastructure to support HOBSCOTCH implementation (intervention delivery and/or patient referral to HI) across the US. In 2023 the HOBSCOTCH Institute Translational Network (HITN) was formed by a collaborating group of 18 diverse epilepsy centers (Fig. 1) to increase patient and provider access to epilepsy self-management (ESM). HI partnered with Dartmouth’s Center for Program Design and Evaluation to assess implementation. Methods:
Site champions at each spoke HITN epilepsy center (EC) distributed anonymous survey links to patient-facing epilepsy providers (n=85) at their clinics. The survey assessed implementation barriers, the value of HOBSCOTCH for patients, and the value of varied supports provided by HI. Response rates varied across questions. Similar surveys were distributed at implementation baseline (n= 84), but samples are not identical across surveys, so comparisons should be interpreted with caution. Survey data was analyzed in Excel.
Results:
Following Year 1 of HITN establishment, most respondents (65%) report that HOBSCOTCH has a great deal of value for patients, compared to 36% of those surveyed at baseline (Fig 2a). Patient referral to HI is the most popular way respondents are engaged in implementation; 56% exclusively refer patients to HI, 14% refer and deliver the program, and 6% only deliver the program to patients at their EC. Most of the respondents (75%) who deliver HOBSCOTCH report it is a top priority, however, 27% feel they lack the time to do so. Of those working at an EC where others deliver HOBSCOTCH to patients, almost all (91%) report that clinic leadership is supportive of delivery, but fewer agree their EC has enough staffing to support it. Alternatively, many (84%) of the respondents who refer patients to HI find the process easy, with some (13%) referring over 20 patients in the past year. Most respondents report that hearing from other ECs (69%) and small group meetings at their EC (58%) are helpful for implementation (Fig 2b).
Conclusions:
Findings provide insight into epilepsy providers’ perspectives on the HOBSCOTCH program, the implementation process, and the most helpful forms of support. Respondents’ high rate of implementation engagement and recognition of HOBSCOTCH’s value for patients demonstrate the impact of HI’s efforts to expand provider education and support during Year 1. Despite barriers to onsite delivery, referral remains a feasible option to expand patient access. Clinical staff cite time constraints as limiting onsite delivery, which supports the need for centralized infrastructure to support access to ESM. HI will utilize these findings to strategize and allocate resources while continuing to engage in quality improvement efforts with HITN partners. Funding:
CDC Cooperative Agreement Award # 1 NU58DP007541-01-00