Abstracts

Rationale: Rationale: The Management Information & Decision Support Epilepsy Tool (MINDSET) is a bilingual tablet-based tool designed to improve patient-provider communication to enhance self-management (S-M) of patients with epilepsy (PWE) through tailored behavioral goal selection. Purpose: To assess the efficacy of MINDSET for longitudinal improvement in adherence to S-M behaviors among Hispanic patients. Methods: Methods: Hispanic adult PWEs (n = 96) at 4 neurology clinics (Epilepsy Foundation Central & South TX, n=2; Banner Univ. Med. Ctr, AZ, n=2) were randomly assigned within clinics to receive either MINDSET with usual care (MINDSET, n=46) or usual care (control, n=48) only and followed for 3 clinic visits over a year. Prior to each clinic encounter, all patients entered seizure, medication, and lifestyle management data into the epilepsy S-M scale items embedded in MINDSET. MINDSET PWE assessed their low- or non-adherent behaviors and selected goals and strategies for improvement; reviewed with their provider a printed action plan (AP) including their self-selected S-M goals, and received a 2-week post clinic ‘booster’ call. Success in achieving S-M adherence goals was assessed at follow-up visits. Control group patients did not receive feedback regarding S-M behaviors that could be improved, were not asked to select goals and strategies, and did not receive an AP or a booster call. Instead, they continued with their regular clinic. Between-group differences were assessed on 1) rates of behavior-level conversion from non-adherent to adherent by condition, and (2) change in S-M subscale scores over time. Results: Results: Patient characteristics: PWE were 18-72 yrs. (mean 39.8 ± 14.1), mostly female (53%), and of Mexican origin (95%). Insurance was mostly public (52%), private (18%), or none (13%). Most had epilepsy for over 16 yrs., had seizures in the last 12 mos. (68%) with 38% having ≥3 seizures per mo. Retention was 95% for 1st follow-up and 89% for 2nd follow-up with 84 (35 in TX, 49 in AZ) completing data collection at 3 time points. At baseline MINDSET PWEs were more likely to have attended college and to be unemployed than controls. Depression was indicated in 25% of PWEs based on NDDI-E criteria. There were no between group differences on epilepsy and S-M characteristics. PWEs in the treatment group preferred English to complete MINDSET (77%). 1) Adherence conversion rates: MINDSET was positively associated with conversion of S-M behaviors from non-adherent to adherent. Among MINDSET PWE, when behavioral goals were selected to increase adherence there was higher conversion rates of those behaviors (60.9%). Behaviors that were not selected for improvement had a lower conversion rate (42.8%). Control PWE had a lower conversion rate (28.6%) for all S-M domains except medication management which was 55%, compared to that of the MINDSET PWE who had selected medication management goals (50%). Further analysis of change in goal-based behavior will be reported. 2) S-M behavior scores: MINDSET patients significantly improved in lifestyle and safety management (p<0.05) from visit 1 to visit 2 and in information seeking (p<0.05) from visit 2 to visit 3. Information seeking increased significantly from visit 1 to visit 3 (p<0.05). Conclusions: Conclusions: MINDSET use is associated with greater conversion to S-M adherence than usual care. Safety, lifestyle, and information seeking S-M behaviors appear most amenable to positive impact. MINDSET is a promising program for Hispanic patients. Assessment of efficacy within a broader population of people with epilepsy is indicated. Funding: Funding source: CDC SIP14-007.