Rationale:
Women with epilepsy face unique reproductive health risks due to the teratogenic potential of antiseizure medications, altered pharmacokinetics during pregnancy, and potential interactions with hormonal contraceptives. Despite these known challenges and the existence of clinical guidelines, provider counseling in this area remains inconsistent. This quality improvement initiative aimed to enhance and standardize provider education and patient counseling by implementing a structured didactic session for residents and an EMR-integrated SmartPhrase with supplemental materials for patient education.
Methods:
Neurology residents (PGY1–4) at an academic center completed a 10-question multiple-choice knowledge quiz and a 10-item confidence survey prior to the intervention. The confidence survey assessed providers’ comfort in counseling women of reproductive age with epilepsy, using a 5-point Likert scale (1- strongly disagree to 5- strongly agree). A didactic lecture on ‘Women with Epilepsy’ was then delivered, followed by the introduction of an EMR-integrated SmartPhrase for patient education. Participants subsequently completed another set of knowledge quiz and a satisfaction survey evaluating SmartPhrase across five domains. All surveys were anonymous. Descriptive statistics and t-test were used to assess outcomes.
Results:
Thirteen pre- and post-lecture knowledge quiz responses were analyzed. The average percent correct increased from 52.3% to 59.2% (SD ± 1.32); however, this improvement was not statistically significant (p = 0.2569). Pre-lecture provider agreement survey scores averaged 2.88 out of 5, with the highest-rated item being “Reproductive counseling should be part of routine epilepsy care” (mean = 4.00) and the lowest-rated item “I am comfortable discussing breastfeeding safety with women on ASMs” (mean = 2.31), revealing substantial gaps in baseline preparedness. Post-intervention feedback on the SmartPhrase was overwhelmingly positive, with average ratings ≥ 4.6 across all categories: Ease of Use (4.6), Enhances Clinical Discussion (4.8), Likelihood of Continued Use (4.9), Standardizes Education (4.9), and Recommendation to Others (5.0). A total of 62% of participants rated all items a perfect 5.0; 100% of responses were ≥ 4.6. These ratings were obtained immediately after the session and prior to real-world clinical use.
Conclusions:
This initiative improved provider confidence and received strong satisfaction ratings for the EMR-integrated counseling tool. Although knowledge gains were modest and not statistically significant, the combination of structured education and standardized documentation showed promise in promoting consistent reproductive counseling practices. Future efforts should include longitudinal evaluation of clinical impact, real-world SmartPhrase utilization, and patient-centered outcomes. Future research assessing compliance with quality measures of patient counseling, documentation and patient outcomes may further support broader implementation across diverse care settings.
Funding: No funding