Abstracts

Rationale: There exists a recognized shortage of Neurologists in the U.S., as recently highlighted in a report from the American Academy of Neurology (AAN) [1], and characterized as a “grave threat” to the quality of patient care provided in Neurology. This also affects Epilepsy care where the treatment of patients diagnosed with epilepsy (PWE) is particularly challenging as there are major uncertainties in terms of optimal prescription of anti-epileptic drugs (AEDs). While 2/3 of them become seizure free, the remaining 1/3 do not respond to medication and are subject to drug resistant epilepsy (DRE). While the recognition of the low availability of care is important, disparities may exist between different areas of the country (rural/urban, states related, etc.) that may exacerbate income/ethnicity inequity. In this study, we perform a geospatial mapping of Epileptologist in the United States and estimate their patient coverage based on the population density at the postal code level. Finally, we provide an interactive dashboard that can be used to assess the availability of care in a map.

Methods: A list consisting of 2,450 Epileptilogists in the U.S. and their addresses were obtained from a publicly available website [2]. We calculated the level of availability for each epileptologist based on the estimated number of PWE in their 30 miles radius who are not being seen by another Epileptolgist. The prevalence of Epilepsy was computed from the density of the population at the zipcode level scaled by 0.004 (0.012 x 1/3) assuming a prevalence of 1.2 percent for epilepsy and 1/3 of them (DRE) that need to be seen by an epileptologist. In turn, this was used to derive an estimated number of patients covered by each Epileptologist, reflecting their overall disponibility to see new patients.

Results: We found that 50% of the postal codes (accounting for 280k PWE who are DRE) do not have access to an epileptologist. Moreover, 40% of zip codes (accounting for 838k PWE who are DRE) have access to an epileptologist who is busy (seeing more than 300 patients in a year). Figure 1 illustrates the availability of care per postal code by associating black circles for areas with no epileptologist within 30 miles. On the other end, yellow postal codes are close to an epileptologist with low availability. Dark green bubbles indicate postal codes with access to an available epileptologist.

Conclusions: We developed an interactive dashboard to represent the availability of care in Epilepsy at the postal code level in the US - taking into account population density. The geospatial analysis allows to identify areas where there is a significant lack of Epileptologists.
_x000D_ References:_x000D_ 1. Majersik JJ, et al. "A Shortage of Neurologists–We Must Act Now: A Report From the AAN 2019 Transforming Leaders Program." Neurology. 96.24 (2021):1122-1134._x000D_ 2. U.S. News & World Report: https://health.usnews.com/. Accessed February 1, 2022._x000D_
Funding: All authors are employees of Nile AI.