Abstracts

This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session.

Rationale: UPLIFT (Using Practice and Learning to Increase Favorable Thoughts) is a telephone-based self-management program shown to reduce depressive symptoms and prevent depressive episodes in people with epilepsy. Given the prevalence and adverse effects of depression in people with epilepsy, offering UPLIFT in epilepsy clinics has the potential to support self-management and improve health outcomes. Identifying barriers and facilitators to program adoption will support translation of research findings to clinical practice. We conducted a mixed methods study to learn about perceived benefits, challenges and capacity to deliver UPLIFT in varied clinical settings._x000D_
Methods: Focus groups were completed with providers and staff from 9 epilepsy clinics in NY and NJ (n=59 participants) with diverse infrastructure, resources, and demographic and socioeconomic (e.g. insurance status) characteristics of their patient populations. Focus group leaders described the UPLIFT program, evidence of its efficacy and implementation logistics (e.g. facilitator qualifications, time, cost). Perceived need for UPLIFT and barriers and facilitators to its adoption at each clinic were discussed. Focus group participants completed surveys via RedCap assessing demographics, clinic roles and perceptions of clinic readiness to implement UPLIFT. Administrators reported clinical data and resources relevant to implementation.

Results: Clinic size ranged from 300 to 15,000 adult epilepsy patients served annually, employing 5 to 50 providers and 6 to 80 staff. All clinics offered telehealth services, but few were currently equipped with staff who could be trained to deliver UPLIFT (n=2) or supervise UPLIFT facilitators (n=3). Four clinics could identify a potential UPLIFT champion. Participants (68% female, 46% racial/ethnic minorities) were neurologists (n=25, 50%), psychologists/ neuropsychologists (n=9, 18%), NP/RNs (n=9, 18%), administrators (n=2, 4%), social workers (n=2, 4%) and trainees/other (n=3, 6%). The implementation readiness survey responses indicated high interest levels in providing UPLIFT but lower levels of confidence in the ability to implement and maintain the program. The majority of clinics expressed intent to adopt UPLIFT, but some preferred a referral approach. Focus group discussion topics included implementation issues such as reimbursement options, clinical supervision, and whether groups should be stratified by patient characteristics (e.g. age, epilepsy severity). A frequent theme was how to frame UPLIFT to maximize patient engagement given the stigma associated with depression, particularly among the clinics’ minority populations. _x000D_
Conclusions: We found widespread enthusiasm for offering UPLIFT in epilepsy clinics. Qualitative data provided valuable perspectives on barriers and facilitators to program adoption, identifying questions that should be addressed in future studies to support UPLIFT dissemination.

Funding: Centers for Disease Control and Prevention (CDC) Managing Epilepsy Well (MEW) Network (SIP 19-003)