Abstracts

Rationale: Epilepsy occurring during childhood places children at risk for psychosocial and educational difficulties impacting long term health and quality of life outcomes in adulthood. Given increasing challenges of delivering comprehensive epilepsy care in daily practice, refining a team approach between primary and specialty care may provide a more realistic model of care to meet the needs of pediatric patients with epilepsy and their families. However, readiness of primary care providers to assume co-management of pediatric patients with epilepsy is relatively unknown. The aim of this pilot study is to assess the attitudes and readiness for epilepsy co-management among primary care providers and to identify resource and learning needs.Methods: A 67-item web-based survey was distributed to pediatric primary providers who are members of the Pennsylvania Medical Home Initiative (MHI) of the PA Chapter of the American Academy of Pediatrics. Questions focused on characteristics of practices and practitioners, views on respective roles of primary care pediatricians and child neurologists in specific care issues for children and youth with epilepsy (CYE) and optimal designated roles. The survey further sought the learning needs of primary care providers to enhance their care to CYE.Results: A total of 21 responses were received from MHI physicians, nurse practitioners, and physician assistants across the Commonwealth of Pennsylvania including urban, suburban, and rural practices, CYE represented 5% or less of the practitioners’ total patient population. Practitioners overall expressed confidence in their ability to address many of the issues faced by CYE, including discussing family adjustment, seizure safety issues, behavioral health, and transition to adult care. The areas of least confidence included supervising anti-epilepsy medication, bone health, and contraception in CYE. Greater familiarity of anti-epilepsy medications, interactions, and side effects were identified as potential learning areas. Greater access to learning resources, support groups, and epilepsy care guidelines were identified as ways to enhance current care.Conclusions: In the setting of pediatric medical homes, respondents generally felt confident and knowledgeable in the many aspects of comprehensive care of CYE. Practitioners are interested in learning more about AEDs. While MHI practitioners were receptive the concept of shared and designated roles for CYE, this group of respondents may not represent the majority of pediatric primary care providers. Future steps may be to partner with a range of primary care practices and examine the benefits of role clarification and facilitation via such tools as care algorithms, educational sessions, and learning communities.