Abstracts

Rationale: Many medications used to treat epilepsy are known to have adverse effects on bone health - in particular, the first-generation, hepatic enzyme-inducing antiepileptic drugs (EIAEDs). Female patients are at particular risk for bone loss later in life; consequently, it is most important for neurologists to counsel women taking EIAEDs about bone health risks during the childbearing years. We sought to identify the prevalence of bone health counseling among neurologists treating female patients with first-generation EIAEDs, and to identify barriers to counseling if present. Methods: We performed a retrospective, observational study to examine prevalence and potential barriers to bone health counseling among academic neurologists treating female patients with epilepsy. We identified 760 females with epilepsy, ages 11-60, by ICD-9 codes for "seizure" or "epilepsy" seen in 2010 at the outpatient academic neurology clinics affiliated with Hasbro Children's Hospital and Rhode Island Hospital (RIH). Outpatient neurology notes for subjects identified were then analyzed over a five-year span (2005-2010) and documentation of AEDs and bone health counseling was collected. We also collected demographic information, primary language, presence of a cognitive disorder, race and ethnicity when known, insurance status, number of outpatient visits over 5 years, and provider expertise (epileptologist versus general neurologist). Results: Among the group of 760 epilepsy patients, 280 were taking first-generation EIAEDs, of whom 53% (148/280) had been counseled about bone health. First-generation EIAEDs were more commonly used by uninsured (39/59, 66%), Medicaid (52/103, 50%), and Medicare (42/85, 49%) patients compared to the privately insured (146/509, 29%). Counseling rates correlated most with insurance status: 31% (16/52) of Medicaid and 36% (14/39) of uninsured patients had been counseled, versus 64% (27/42) of Medicare and 62% (91/146) of privately insured patients (p < 0.001). Counseling also correlated with patient age, with 10% (2/21) of patients under 20 counseled versus 66% (37/56) of those aged 51-60. Primary language or the presence of a cognitive disability did not influence counseling rates, and race and ethnicity data were incomplete. Median age was higher among Medicare (46) and Medicaid (44) versus private (28) and uninsured (34) groups. Conclusions: Among neurologists treating female patients with first-generation EIAEDs for epilepsy, insurance status and age correlated most with bone health counseling rates. Uninsured or Medicaid patients were about half as likely to be counseled as privately insured or Medicare patients (p = < 0.001). Yet, first-generation EIAEDs were more commonly prescribed to uninsured or Medicaid patients compared to privately insured patients. Age was also a barrier to counseling; patients younger than 20 years old were counseled the least. Further study into barriers to counseling is warranted, as is a streamlined quality improvement intervention to remedy these apparent disparities in counseling practices among neurologists.