Abstracts

Rationale: The Management Information & Decision Support Epilepsy Tool (MINDSET) is a tablet-based decision support system designed to enhance self-management of patients with epilepsy though identifying needs, providing tailored goals, and facilitating communication between patients and health care providers (HCP) during regular clinic visits. The feasibility and perceived usefulness of MINDSET has been shown in previous studies. This abstract describes the study and preliminary findings of a pilot randomized trial of MINDSETconducted to evaluate its efficacy in improving self-management over consecutive clinic visits. Methods: A randomized clinical trial was conducted with 42 adult patients at three participating neurology specialty clinics. Patients were randomly assigned to receive either MINDSET with usual care or usual care only and were followed for three clinic visits over a 9-10 month period. Prior to each clinic encounter MINDSET patients entered seizure, medication, and lifestyle management information into MINDSET and received a printed action plan identifying at risk behaviors and prioritizing improvement strategies. This was reviewed by the patient and provider during the visit and taken home by the patient as a decision aid. During follow-up visits, patients were able to assess their success in meeting self-management goals (based on changes in their self-management behaviors since the prior visit). Results: Recruited patients ranged in age from 18 to 68 years (mean: 38), were mostly female (69%), and were 48% White, 31% African American, and 26% Hispanic. They had commercial insurance coverage (31%), no insurance (31%), Medicaid (12%), Medicare (10%), or did not know their coverage (10%). Most had epilepsy for over 18 years, and 88% reported having seizures in the last 12 months, 67% more than one seizure per month, 7% not had a seizure in the last 12 months, and 5% could not remember. All 42 patients have completed the first visit and 13 have completed two visits. There were no significant differences at baseline between the treatment and control groups on demographic variables. The depression criterion on the NDDI-E (scale score greater than or equal to 15) was met by 49% of the patients. There were no significant differences at baseline between the treatment and control groups in self-management scores, which ranged from 92 to 160 (mean 128.68 (±19.316) out of 180 possible. No significant between-group differences were found for communication effects suggesting MINDSET did not hamper the clinic encounter but did not enhance it either. Items flagged by MINDSET in visit one are consistent with our previously reported feasibility trials. Conclusions: Baseline demographic, self-management, and depression scores are consistent with our previous studies, and indicate no significant differences between treatment and comparison groups. Final results will examine between-group comparisons of the changes in self-management behaviors and mediating factors over the trial period.