Abstracts

Rationale: The efficacy and safety of epilepsy surgery have been supported by a large number of studies, yet only a small minority of such patients in Ontario actually undergoes surgery. A survey was designed to explore referral practices and knowledge of epilepsy surgery among family physicians in Ontario Methods: The survey addressed 3 major aspects:respondents' demographics (age, years in practice, gender, and practice setting), referral practices, and general knowledge about epilepsy surgery. Survey data were collected anonymously. We targeted family doctors in Ontario to complete our survey as they represent the first contact of all patients with epilepsy. We obtained a list of family doctors registered with the College of Physicians and Surgeons of Ontario in 2013 and randomly selected 400 from the total of 14191 to complete our survey. Surveys were initially mailed to the family physicians, along with invitation letters and $30 gift cards. Two monthly follow-up mailings were sent out to the same doctors to help ensure response rate. 12 of these surveys were returned uncompleted. As a result, we randomly selected 12 additional physicians to complete the surveys. A total of 201 surveys out of 400 were completed and returned (50% compliance). Descriptive statistics are presented Results: 53% were male, 75% practice in an urban setting. Ages ranged from 41 to 70+ years (30% between 41-50). The respondents varied widely in terms of the number of years in practice; the largest cohort (28%) had been practicing for 31 to 40 years. 87% indicated they managed adult patients with epilepsy in their practice. Nearly 81% indicated that they would "always" refer patients with epilepsy, in sharp contrast to the small minority (4%) who indicated they would "never" refer patients with epilepsy. Of those who referred their patients with epilepsy, most referred them to general neurologists (89%) while only 4% referred their patients to an epileptologist. The majority (54%) felt that surgery should be considered "in selected cases" for the treatment of epilepsy, though a similarly sized majority (53%) did not know what type of epilepsy can be surgically treated. Additionally, 44% and 45% were unfamiliar with the risks associated with epilepsy surgery and its potential benefits, respectively. Among those who felt surgery should be considered "in selected cases", only 2% referred their patients to epileptologists, while 48% of these respondents referred their epilepsy patients to general neurologists Conclusions: The results are consistent with the idea that there is a knowledge deficit among family physicians in terms of when surgery ought to be considered, the types of epilepsy that are amenable to surgical treatment, and the risks and benefits of epilepsy surgery. A lack of knowledge in these areas may partly underlie low referral rates of epilepsy patients, though other factors must be considered, such as access to neurologists and epileptologists. Education campaigns directed at family physicians may improve knowledge and change referral practices.