Abstracts

Rationale: Effective and efficient provider–patient communication is one of the most crucial factors for optimizing health outcomes in people with epilepsy (PWE). Since 20% of Americans speak languages other than English, many PWE are at risk for the harmful effects of language discordance: including delayed time to diagnosis, poor patient rapport, and unfavorable treatment outcomes¹. In the United States, Spanish is the most common language requested by patients with limited English proficiency (LEP)². Despite this, only a few practicing neurologists currently speak Spanish fluently. While healthcare inequalities have been examined for common diseases including cancer, heart disease, and stroke, the effect of language discordance between English and Spanish with respect to epilepsy outcomes has not been investigated. The objective of this retrospective chart review is to evaluate the effect of LEP in Spanish-speaking PWE and its impact on factors such as ER visits and missed clinic appointments.

Methods: This single-center retrospective chart review analyzed data from patients who established care in the outpatient Epilepsy clinic between 1/1/2021 and 1/1/2023. Demographic and clinical factors including preferred language, were gathered from the medical record. We performed t-test analyses controlling for age and sex to determine any statistically significant differences in the number of seizure-related ER visits, missed epilepsy clinic appointments, telephone encounters, and MyChart messages between English-speaking PWE and Spanish-speaking PWE.

Results: 70 participants were enrolled: 37 English-speaking PWE and 33 Spanish-speaking PWE. Spanish-speaking PWE were more likely to miss at least one epilepsy appointment (p=0.004) and less likely to send more than 3 MyChart messages (p=0.01) compared to the English-speaking PWE. Also, a higher proportion of Spanish-speaking PWE had seizure-related ER visits (21%) within 6 months of establishing care with an Epileptologist compared to English-speaking PWE (5%), but this did not reach statistical significance (p=0.07).

Conclusions: We found evidence of worse outcomes (missed epilepsy appointments) and underutilization of communication services (fewer MyChart messages) in Spanish-speaking PWE. These data suggest the need for larger studies and further research into what factors may influence the observed outcomes. Gaining a better understanding of possible risk factors in this sizable and expanding segment of the US population could have a profound effect on the treatment of PWE with LEP.

Funding: Rush University Medical Center, Neurological Sciences