Abstracts

Rationale:
Up to 50% of youth with epilepsy (YWE) suffer from comorbidities such as depression, anxiety, ADHD, and neurodevelopmental disorders. However, comorbidities often go undiagnosed and untreated due to time and resource constraints in clinic. This is the initial phase of a larger study aiming to implement a formal screening program during child epilepsy clinic to identify and manage comorbidities. We aimed to 1) establish the baseline rate during standard of care neurology visits for discussing comorbidities in YWE and referring for additional services; and 2) compare rates of comorbidity discussion and referral rates when a mental health provider (MHP) is embedded in clinic. We hypothesized that rates of comorbidity discussion and referrals would be higher in clinics with a MHP present.
Method:
Retrospective medical record review was conducted for 100 patients previously seen in epilepsy clinic (range=5-21yrs, mean age=12.4yrs, SD=4.5yrs, 54% male). Patients were selected chronologically across a 4-month timeframe from epilepsy clinics, with 50 clinics with an embedded MHP and 50 clinics without a MHP. Clinic notes were coded for: discussion of psychosocial comorbidities; known comorbidities; current services; and referral for additional services. Descriptive statistics and chi-square analyses were conducted.
Results:
Comorbidity was documented in clinic notes for 63% of patients and discussed in 50% of visits (Table 1). The most commonly identified comorbidity was intellectual/developmental delay (31%). Providers noted current services for 32% of all patients. Referral for additional services was made for 23% of all patients (Table 2), with 65% of those referrals (n=15) for patients with no documented services. Referral rate did not differ based on whether the patient already had services. Referral rate was higher when a discussion of comorbidities was held, X2=.451, p< .001 and if the patient had a history of comorbidity, X2=.271, p=.007. MHP presence was not significantly related to discussion or type of comorbidities identified or referral for services.
Conclusion:
YWE had high rates of psychological and neurodevelopmental comorbidities, yet when analyzed by type, documentation was similar to known rates of comorbidity for intellectual/developmental delay and autism, but was below or at the lowest end of reported rates for LD, ADHD, depression, and anxiety. Moreover, rates of existing services and referral rates for services was low but was more likely for patients with history of comorbidity. Taken together, our data suggests that neurology providers recognize and address more severe and already established comorbidities. Conversely, they are less likely to refer for assessment/treatment for less apparent or undocumented concerns. Presence of MHP alone was not associated with improving frequency of comorbidity discussion or referral for services. Addressing comorbidities during the neurology visit is challenging. Our next phase is to implement use of universal standardized measures during clinic, which we hypothesize will improve identification of comorbidities.
Funding:
:The Hess Foundation