Authors :
Presenting Author: Tresah Antaya, MPH – Western University
Brooke Carter, MSc – ICES Western; Salimah Shariff, PhD – ICES Western; Lysa Boissé Lomax, MD, MSc – Queen's University; Elizabeth Donner, MD, M.Sc., FRCPC – SickKids Hospital; Kirk Nylen, PhD – University of Toronto; O Carter Snead, MD – University of Toronto; Jorge Burneo, MD, MSPH – Western University
Rationale:
A previous study using data from 2001 to 2010 found that just 1.2% of patients in Ontario, the most populous province in Canada, received epilepsy surgery within two years of drug-resistant epilepsy diagnosis. This figure indicates that epilepsy surgery was underutilized in Ontario. In 2016, the Ontario Ministry of Health and Long-Term Care implemented the Provincial Strategy for Epilepsy Care to address this issue. The Provincial Strategy consisted of increasing the number of video-EEG beds and medical personnel and creating District and Comprehensive Epilepsy Programs. The objectives of this study were to assess whether the use of (1) epilepsy surgery, including (a) its receipt and (b) assessment for candidacy, and (2) other healthcare for epilepsy, including (a) neurological consultations, (b) emergency department visits, and (c) hospital admissions, changed since the Provincial Strategy was implemented.
Methods:
We used administrative health data and an interrupted time series design. Annual cohorts were created for July 1st to June 30th of each year between 2007 and 2019, comprising patients with drug-resistant epilepsy eligible for the Ontario Drug Benefit program with no history of cancer. We used segmented Poisson regression models to assess whether the annual incidence of each outcome changed between the period before the Provincial Strategy was initiated (July 2007 to June 2016) and the period after.
Results:
The Provincial Strategy immediately increased the rates of epilepsy surgeries and assessments for candidacy by 48% (95% CI: 0%, 118%) and 41% (95% CI: -1%, 99%), respectively. The Provincial Strategy was also associated with a 10% per year decline in the rates of both neurological consultations (95% CI: -15%, -5%) and emergency department visits (95% CI: -20%, 1%), and a 7% per year decline in the rate of hospital admissions (95% CI: -12%, -1%).
Conclusions:
These findings suggest that the Provincial Strategy increased the use of epilepsy surgery and assessments for candidacy. The program establishment was also associated with a declining incidence of neurological consultations, emergency department visits, and hospital admissions for epilepsy. Although not all these findings are statistically significant, it is likely that we had insufficient power given the small number of events, particularly for surgeries and assessments for epilepsy surgery candidacy.
Funding:
Funding provided by the Ministry of Health and the Ministry of Long-Term Care through Project ECHO (Extension for Community Healthcare Outcomes) Epilepsy Across the Life Span and the Jack Cowin Chair in Epilepsy Research at Western University.