Abstracts

Rationale: A significant portion of newly diagnosed persons with epilepsy experience a delay in care. By one estimate, as many as one-third of such patients remain untreated with an anti-epileptic drug (AED) at 3 years from diagnosis (1). Such treatment gaps disproportionately impact people of lower socio-economic status and those in rural areas (2). Methods: We retrospectively analyzed data from electronic health records in the Dartmouth-Hitchcock (D-H) Health System, which serves patients in Northern New England. A cohort of incident epilepsy cases was derived of patients with one or more visits with an epilepsy diagnosis code (ICD-9 345.XX) during 2012-2013, or two seizure events (ICD-9 780.3X). Patients with a previous 345.XX or 780.3X code were excluded. Additional data collected includes sex, insurance payer, marital status, employment status, comorbid conditions, and first AED type and prescription date. Results: Our cohort was 48% women and 52% men. 43% used private commercial insurance, 37% used Medicaid, and 13% used Medicare. The majority of patients were prescribed an AED within 30 days of the index date, however ~5% waited 3 months - 1 year, and ~6% waited more than one-year. Of the eligible patients, ~70% presented with a seizure code (780.3X) at the index date. Within this group, the median days from first seizure (780.3X) to epilepsy diagnosis (345.XX) was ~230 days, and some of these patients had as many as 30 comorbid condition codes. Approximately one-third of these patients had >1-year of delay prior to the diagnosis of epilepsy. The mean age of the patients with >1-year of delay was slightly lower (23 vs. 32 years of age, p=0.1), and this delay somewhat more common among patients on Medicaid (delay >1-year 49%, <1-year 30%). Additional factors associated with delayed diagnosis will be assessed. Conclusions: In line with previous research that indicates treatment gaps, the present study shows a delay between a first seizure and a diagnosis of epilepsy. Funding: This work was funded by the CDC Special Interest Project Competitive Supplement 5U48DP005013-05-SIP18-001.