Authors :
Presenting Author: Amanda Gordon, MSN, NP-C – Atrium Health
Chrisanne Barnes, MSN, RN, AGCNS-BC – Atrium Health; Casey Cruse, BSN, RN, CNRN – Atrium Health; Heather Hughes, BSN, RN – Atrium Health; Amber Meadows, BSN, RN – Atrium Health; Ashley Moore, MBA, BSN, RN – Atrium Health; Dona Navey, DNP, AGNP-C – Atrium Health; Rajdeep Singh, MD, MS – Atrium Health
Rationale:
The Managing Epilepsy Well (MEW) Network developed various self-management programs, including Project Uplift and HOBSCOTCH, to address comorbid conditions in patients with epilepsy. Healthcare institutions who treat large volumes of epilepsy patients are key stakeholders in these programs' implementation. At Atrium Health, with a level 4 epilepsy center and a community-based level 3 epilepsy center, we felt to be in a unique position to implement these programs.
Phase 1 of our implementation identified barriers to patient recruitment and retention. Out of 552 completed questionnaires over 18 months, only 11 patients successfully completed the programs. Given these outcomes, we changed our methods for recruitment.
Methods:
We selected our epilepsy navigators to facilitate these programs. Our initial strategy included recruiting patients from the clinic based on a six item questionnaire (attached) given to each patient. The completed questionnaires were reviewed by staff and patients were contacted if deemed appropriate. This method was used to have minimal impact on the workflow of providers. While we had a significant interest in the program according to completed questionnaires, we had a challenging time getting patients to start the programs and retain them once they did start.
So, we changed our strategy instead to rely heavily on patient education through brochures and posters in clinics and email messages through our secured portal. We sent information about the programs via patient portal to all patients within the epilepsy clinics. After education, patients were told to call and self-refer if interested.
Results:
We had only 16 patients enrolled in all combined programs in one year when they were screened by clinical staff, even though more patients were identified with this method. With the second method of providing written and verbal education, and then asking the patients to self-refer if they seemed appropriate for the programs, 21 patients have already been enrolled in a shorter time span. The table below compares recruitment numbers from our previous method versus the current one and gives the enrollment breakdown by each program.
Conclusions:
Despite evidence showing the efficacy of the programs, there are challenges for successful implementation at the community level. We have found that focusing more time and effort on education and allowing patients to self-refer has increased interest and enrollment in the program. It also seems that when patients self-refer, they are more dedicated to completing the program. In our institute, barriers continue to include timing of offered opportunities and the 8-week commitment from patients. From an institutional standpoint, having time for staff to complete programs for all interested patients continues to be a barrier. Next Steps: Based on the above information, we feel that through the remainder of 2023 and into the coming years, we will be able to significantly increase the number of patients who have completed a self-management program. Once we have reached a significant amount, we hope to look at the effects on health care utilization including compliance and emergency room visits.
Funding: None