Abstracts

Access to healthcare is unsatisfactory in indigent patients with epilepsy. Multiple factors hinder in the access to healthcare including absence of insurance. Many epilepsy patients use the hospital emergency room as a primary or secondary source of care for their seizure disorder. Many indigent patients do not see an epilepsy specialist for long term care. We wished to find the factors that affect the access to healthcare in these indigent epilepsy patients., We obtained data of patients seen in the ER for seizures in 2002 and 2003, in two institutions, Vanderbilt University Hospital (VUH) and Metro Nashville General Hospital (MNGH), seeking to identify patients who had visited the emergency room more than once. Vanderbilt is a tertiary care institution while MNGH serves the more underserved population. We also collected insurance information of these patients, and compared them to the outpatient VUH epilepsy clinic data. We did a chart review to identify these patients who finally followed up in the epilepsy clinic., A total of 702 patients visited the VUH ER and 446 patients visited the MNGH ER for seizures. Of the VUH patients, 125 patients visited the ER more than once. Of these patients who visited ER multiple times, 69 (55.2%) finally followed up in the epilepsy clinic and of those, 24 patients (34.8%) were already followed by an epileptologist. Patients who visited the ER mulitple times, 31 (25%) carried private or commercial insurance, 91 (73%) carried Medicare or Medicaid, and 3 had no insurance. The 69 patients who followed up in the clinic, 19 (61.3%) carried private insurance, 50 (55%) carried Medicare/Medicaid. The average duration between the first ER visit to the first clinic visit was 196 days with those who carried private insurance averaged 91 days and those with Medicare/Medicaid averaged 236 days.
Of the 446 MGNH patients, 157 (35%) visited the ER more than once. Of these 157 patients, 36 (23%) finally followed up in the outpatient Neurology clinic. Of these patients who made multiple ER visits, 0.9% patients had commercial insurance, 38% carried Medicaid, 12% Medicare and 36% were self pay. None of the commercial insurance carriers followed up in clinic while 31 (86%) of the Medicaid/Medicare carriers and 3 (8%) of the uninsured patients had. The average duration of time between the first ER visit and the first clinic visit was 73 days, 71 days for the Medcare/Medicaid carriers and 84 days for the uninsured, Among indegent patients using ER for treatment of epilepsy is not adequate and there is still considerable lack of long term follow up of seizures in outpatient setting. Overall this results in disparity of care in indigent patients and adds tremendous cost to society. This study emphasizes the importance of better epilepsy management and educational and social programs for those with epilepsy.,