Authors :
Presenting Author: Amanda Dunlop, MSN, DNP, FNP-BC, CNRN – OhioHealth, Riverside Methodist Hospital
Diane Manche, MSW, LISW-s – Social Worker, Epilepsy Clinic, Ohiohealth
Rationale:
The purpose of this project is to evaluate outcomes of Neurology Certified Nurse Practitioner (CNP) lead Psychogenic Nonepileptic Seizure (PNES) clinic implemented during the Covid-19 pandemic. The intent of the PNES Clinic is to incorporate evidence-based best practices to create pathways to appropriate clinical care, close the gap in care that currently exists for this patient population, retain patients within our system and ultimately, improve the health of those we serve. The initiatives of the project are to improve quality of life, improve symptoms, and reduce the number of seizure events. Data was collected for program evaluation and quality improvement.
Methods:
A multidisciplinary work group including representation from both epileptology, psychiatry, and administration developed an evidence-based, streamlined program to offer patients treatment for PNES. The program was modeled from LeFrance’s program incorporating concepts of cognitive behavioral therapy (CBT) and mindfulness (Reiter, Anderson, Reiter & LeFrance, 2015; LeFrance & Winze 2015). The program was modified due to resource restraints during the Covid-19 pandemic. This project was approved by the IRB as a quality improvement initiative. Participants over the age of 18 with a diagnosis of video-electrocephalogram (vEEG) confirmed PNES were enrolled in the program beginning April 2021. Over a 24-month period, data was collected for program evaluation and quality improvement. During the program, participants met with an Epilepsy CNP to reinforce the diagnosis and treatment recommendations, develop individualized planning for returning to activities such as work and driving, and medication management. Participants met with the CNP for an initial consultation and follow up at three months and one year. Additional appointments were offered as needed. Participants also met with the epilepsy social worker for education and referral to treatment resources at consult and as needed. Participants were primarily referred to outpatient counseling as resources for internal psychotherapy were only offered for during six months of the program. Anxiety and depression scores were measured using the GAD-7 and PHQ9 at each visit. Patients were also assessed for subjective improvement of symptoms, seizure frequency, ability to work, and ability to drive. Demographic data, retention rates and healthcare utilization for seizure related emergency department visits were also evaluated.
Results:
During a 24-month evaluation period, 158 participants were referred to the PNES program. There were 131 participants that completed an initial consult (82.9%). Program retention was 88.7% at three months and 85.5% at one year. Sixty-seven percent of participants had adherence with psychotherapy recommendations. Participants enrolled in the program also showed a reduction in ED visits, reduction of anxiety scores, and improvement of self-reported symptoms.
Conclusions:
A Neurology CNP lead PNES program can improve patient engagement in treatment recommendations, reduce healthcare utilization, and improve quality of life outcomes for patients with PNES.
Funding: N/A