Authors :
Presenting Author: Trina Dawson, BA – Dartmouth Health
Sarah Kaden, BA – Dartmouth Health
Megan Stabler, PhD – Dartmouth Health
Timothy Burdick, MD – Dartmouth Health
Barbara Jobst, MD, Dr. MED, FAES, FAAN – Dartmouth Health
Laura De Muro, MS, CHW – Dartmouth Health
Meredith Olenec, BA, CHW – Dartmouth Health
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth Health
Rationale:
Epilepsy is a complex condition with manifold variables contributing to optimal management. Often, primary care providers are the sole medical providers for a person with epilepsy (PWE). Engaging these providers as champions of epilepsy self-management (ESM) allows for ESM access to expand beyond patients who receive care at epilepsy clinics, reaching populations that may face limited access to specialty support services due to geographic, socioeconomic, or systemic barriers. This study evaluates the frequency and characteristics of primary care and specialist patient referrals to the HOBSCOTCH Institute at Dartmouth Health between January 2024 and May 2025.Methods:
rimary care (PC) participants (n=50) were referred through an embedded EHR best practice alert (BPA) and epilepsy clinic (EC) referrals (n=53) came directly from the provider through an EHR embedded referral completed at the time of patient check out from clinic. PWE referred to the HOBSCOTCH program were contacted by a HI coordinator to assess eligibility and collect voluntary self-report baseline data (REDCap secure database), including the Global Assessment of Severity of Epilepsy (GASE), seizure control information, care team composition, and prior experience with self-management programs. Pre-intervention participants completed a voluntary pre-survey (primary care n=38, epilepsy clinic n=30) including the Quality of Life in Epilepsy inventory-10 (QOLIE-10) and the Everyday Memory Questionnaire (EMQ-R) to evaluate quality of life and memory functioning, respectively. Data were analyzed in Excel and SPSS.
Results:
At baseline, both groups were similar in gender and age (Table 1). EC referrals were more likely to report inability to work secondary to epilepsy (49% vs 14%), higher epilepsy severity via the GASE (27% extremely/very/quite severe vs. 18%; Figure 1), and uncontrolled seizures (62% vs. 16%). Conversely, PC referrals were more likely to report receiving care from a psychiatrist (14%) or psychologist (12%; epilepsy clinic=11% and 8% respectively). Mann-Whitney U tests revealed a significant difference between groups for both QOLIE-10 (EC mean= 2.96, SD 0.69 vs PC mean= 2.39 SD 0.65; p=.003) and EMQ-R (EC mean=31.33, SD 12.82 vs PC 21.11, SD 15.22; p=.007) scores, indicating that referrals from primary care had better QOL and better day-to-day memory. Conclusions:
Referrals from primary care reported less severe epilepsy and fewer day-to-day cognitive difficulties, but they were more frequently linked to behavioral health utilization compared to those from the epilepsy clinic, underscoring the importance of empowering and supporting primary care teams in addressing the comprehensive needs of individuals with neurological conditions. Strengthening referral pathways in primary care settings is essential to ensuring timely and equitable access to resources for a broader patient population.
Funding:
CDC Cooperative Agreement NU58DP007541-01-00