Rationale: Access to specialist care for people with epilepsy (PWE) can lower premature mortality risk [1]. In adult PWE, several factors contribute to clinic attendance delay as a specific type of delay-to-diagnosis [2, 3]. Patients from historically underrepresented ethnoracial groups tend to have lower rates of referral to neurology subspecialists with Black patients being less likely to see a specialist compared to their White counterparts [4]. In our prior work, we proved the feasibility of creating a new epilepsy-centric outpatient clinic model to increase access to specialist care and diagnostic testing for PWE from a vulnerable population in St Louis, Missouri [5]. In the present study, we sought to evaluate whether this clinic intervention increased health services utilization and decreased attendance delay by reducing clinic no-show rate among participants.
Methods: A retrospective, observational study of an interventional outpatient epilepsy resident clinic that started on 7/1/2023. Eligibility: patients referred with suspected or confirmed seizures/epilepsy are preferentially scheduled in this weekly clinic. Health record audits were done for eligible patients seen in this clinic between 7/1/2023 and 5/1/2024. Demographic and clinical data were recorded. The primary outcomes were clinic no-show rates, proportion of patients staffed by an epilepsy specialist, and ordering/completion of EEG and brain MRI rates. Data analysis included descriptive statistics and linear regression.
Results: 425 patients were included. The cohort was predominantly Black (55.8%) and White (41.2%) races. 26.8% of patients did not attend their appointments (no-show rate). Over the 10-month period, no statistically significant change in the total no-show rate (see figures) occurred. Of the total no-show proportion, there was a relative decrease in the proportion of no-shows for Black patients and a relative increase in the proportion of no-shows for White patients over the study period (see figures). The proportion of patients seen by an epilepsy specialist was 77.1%. The MRI and EEG completion proportion was high between 81.5-84.4%.
Conclusions: Access to care is multidimensional and differentially available for PWE. Thus, simply building a clinic to increase access without addressing external barriers (e.g, structural or social determinants of health) did not appear to significantly modify health utilization through improving clinic attendance for
all patients in this model. However, there was a trend ray of hope with Black patient no-show rates declining over time. Patients attending clinic had higher chance of being seen by an epilepsy specialist and high completion rates of recommended diagnostic testing (MRI and EEG). Limitations include effects from referral or selection bias at an academic center. Future directions should investigate additional targets related to structural or social determinants of health to improve health equity in this population.
References:
- Lowerison, M.W., et al., Jama Neuro, 2019.
- Alessi, N., et al., Epilepsia, 2021
- Minshall, I. et al., Seizure, 2017.
- Willis, A.W., et al., Neurology, 2011.
- Williams, J.P, et al., AES Annual Meeting, 2023
Funding: None