Abstracts

Rationale: The management of people with epilepsy can often be challenging, particularly for those with complex epilepsies. The lack of access to neurologists and epilepsy specialists may impact the quality of care of people with epilepsy due to practice variation. For example, Neurologists have been shown to prescribe different antiseizure medication than primary care physicians. People with epilepsy not followed by a specialist have been shown to have higher hospital and emergency department (ED) visits. The objectives of our study were to examine access to specialist neuro-related care for persons with epilepsy and determine if specialist care was associated with lower emergency room visits or hospitalization. Methods: Population-based administrative health data between April 1, 2002 to March 31, 2012 (physician claims, emergency visits and hospitalization) were linked using personal health numbers recorded in the provincial health registry. Those with epilepsy had to meet the following previously validated case definition: 2 physician claims or 1 hospitalization or 1 ED visit coded for epilepsy using the ICD-9-CM code 345 or ICD-10 G40 between April 1, 2002-March 31, 2004. Visits to neurologists and/or neurosurgeons between years 2004 to 2012 were categorized into 3 groups: (1) Followed by a neuro specialist at least once every 2 years; (2) Not seen by a neuro specialist at all; and (3) Saw a neuro specialist during the study period but did not meet criteria for group (1) above. Neuro visits were stratified by age, sex, location of residence and (urban vs. rural). The association between neuro specialist care and health care utilization (hospital admissions and ED visits were examined). Results: We identified 12,645 people with epilepsy, with a mean age of 36.2 year. The majority lived in urban settings (78.9%). Both sexes were equally represented (males=51.1%). During the study period, 2556 (20.2%) people with epilepsy were followed by a neuro specialist at least once every two years, 5743 (45.4%) were not seen by a neuro specialist at all, and 4346 (34.4%) were seen at least once but less than once every two years. There was a significant difference in age between those followed by a neuro specialist (mean=35.5 years), and those who were not (mean=36.1 years, p=0.03). Those who were followed by a neuro specialist had more hospitalizations (2.4); and ED visits (12.2) during the study period compared to those who were not (1.7 and 11.1 respectively) regardless of age, sex or location of residence (p<0.0001). Conclusions: ​The results of this study suggest that a large proportion of persons with epilepsy are not receiving neuro specialist care on a regular basis. Contrary to previous findings, those followed by a neuro specialist at least every two years in this study had more hospitalizations and emergency visits than those who were not. Future studies exploring reasons for low specialist contact for those with epilepsy and higher emergency and hospital based care for those followed by a neuro specialist are warranted.