Abstracts

Rationale: A 2008 in-office linguistic research study (Phase I) of naturally occurring interactions between community-based neurologists and patients with epilepsy revealed limited assessments and post-visit misalignment regarding side effects associated with anti-epileptic drugs (AEDs) and mood/behavioral problems such as depression, anxiety, and irritability. A follow-up study (Phase II) was conducted to determine if and how neurologists incorporate a pre-visit assessment tool comprised of elements from the Adverse Events Profile and Neurological Disorders Depression Index in Epilepsy screener in routine office visits. Changes in these interactions were evaluated by comparing the conversations from visits pre- and post-introduction of the assessment tool. The short-term impact of the tool was also quantified regarding neurologists’ understanding of patients’ side effects and possible mood/behavioral conditions. Methods: A brief internet-based training session was conducted to share the results of Phase I with the 20 neurologists who had participated. They also were introduced to a pre-visit assessment tool to be used during routine visits with patients with epilepsy. Discussions between neurologists and 60 of their patients were recorded, and both parties were interviewed separately post-visit to capture their perceptions of the interaction. All dialogue components were transcribed and analyzed using validated sociolinguistic models. Outcomes from Phase I and Phase II were compared, and the statistical significance of the results was calculated. Results: Side effects were discussed more often (6.0 vs. 4.0 per visit on average) and in a higher proportion of visits (100% vs. 75% of visits with patients on AEDs) in Phase II than in Phase I. Side effect conversations continued to be initiated more often by neurologists; patients confirmed a greater proportion of side effects in Phase II (44% vs. 27%). Compared to Phase I, an increase was seen in discussions assessing 3 or more side effects and/or lasting greater than 60 seconds (89% vs. 59% of visits). Neurologists and patients mentioned mood/behavioral problems more frequently in Phase II (90% vs. 23% of visits). The average number of issues discussed per visit increased from 2.0 to 4.7. In post-visit interviews, neurologists were more likely in Phase II than Phase I to be aligned with patients regarding what side effects or mood/behavioral issues patients experienced. These measureable differences occurred without a statistically significant change in overall visit length. Conclusions: Linguistic analyses of in-office dialogue and post-visit interviews revealed measureable improvements in several areas, likely attributable to use of the pre-visit assessment tool. Specifically, visits contained more discussion of side effects and mood/behavioral issues without statistically increasing visit length. The tool focuses visit discussions on critical issues and gives neurologists valuable information, helping to individualize treatment decisions and optimize patient care.