Abstracts

Rationale: Comorbid depression and poor quality of life have not been well characterized in their effects on healthcare utilization amongst persons with epilepsy (PWE). This study aims to assess the impact of these and associated demographic factors on 90-day physician and diagnostic services utilization at baseline in a population of PWE enrolled in the Home Based Self-management and Cognitive Training Changes Lives (HOBSCOTCH) Phase II clinical trial. Methods: This study was designed as a retrospective cohort analysis. Mean age of participants was 49.8. Quality of life was assessed using the Quality of Life in Epilepsy (QOLIE-31) survey and depression was measured using the Patient Health Questionnaire (PHQ-9) survey. Healthcare utilization in the 90 days prior to baseline assessment was recorded and included measurements on number of visits to and telephone consults with primary care physicians and neurologists/epilepsy specialists as well as number of diagnostic services utilized. Comparisons between groups with and without healthcare utilization were completed using chi-square tests for categorical measures and t-tests for continuous measures. Results: Age, sex, ethnicity, race, years of education, employment status, household size, marital status, age at diagnosis, seizure frequency, seizure control, and self-reported health status did not differ significantly when comparing PWE who had phone consults with physicians, visited neurologists and epilepsy specialists, and utilized diagnostic services with those who did not (P>0.05). Mean QOLIE-31 scores differed between PWE with zero telephone consults with primary care physicians, neurologist, and epilepsy specialists (=55.3; N=20) and those with one or more (=42.4; N=10). Lower QOLIE-31 scores were associated with increased number of telephone consults (P < 0.045). QOLIE-31 scores also differed between PWE with zero visits to a neurologist or epilepsy specialist (=61.7; N=7) and those with one or more visits (=47.8; N=23). Lower QOLIE-31 scores were also weakly associated with increased specialist visits (P=0.052). Finally, both QOLIE-31 and PHQ-9 scores differed between PWE with zero (QOLIE-31=55.8; PHQ-9=6.7; N=15) and one or more (QOLIE-31=43.3; PHQ-9=12.7; N=15) diagnostic services utilized. Lower QOLIE-31 and higher PHQ-9 scores were associated with increased utilization of diagnostics such as blood tests, urine tests, ultrasound, X-ray, CT, MRI, EEG, and neuropsychological testing (QOLIE-31: P=0.008; PHQ-9: P=0.01). Conclusions: Generally, enrolled PWE who had lower quality of life (lower QOLIE-31 score) and increased symptoms of depression (higher PHQ-9 Score) utilize more physician and diagnostic services. These results highlight the significance of comorbid depression and poor quality of life in driving the healthcare utilization habits of PWE. Funding: CDC: U48DP005018, 3U48DP001935-04S3 NIH: 5R01NS074450-02 DARPA: Prime Award N66001-14-2-4-31