Abstracts

Rationale: There is a gap in how often clinicians counsel patients about SUDEP (Epilepsy Behav 2014;35:13-18). An understanding of differences in counseling practices is needed to develop targeted interventions. The current study will use documentation in physician notes to evaluate SUDEP counseling practices from six academic medical centers in New York City. Methods: We searched clinician notes for SUDEP and counseling keywords from six medical centers from 2010-2014. Manual chart review was used to code patient, physician, and visit factors. Aim 1. Physicians who provided SUDEP counseling were divided by median split into more frequent counselors (top 50th percentile, n=17) and less frequent (n=18). Groups were compared for years of clinical experience using t-test, and proportion of associate professor or professor vs. assistant professor using fisher's exact test. Aim 2. We evaluated factors associated with SUDEP counseling vs. general safety counseling using multivariate logistic regression. Aim 3. We evaluated factors associated with SUDEP counseling to improve seizure control (e.g., medication compliance) vs. education only using multivariate logistic regression. Results: SUDEP counseling was documented for 355 of 77,924 patients (0.5%). Most patients were counseled by epileptologists (99%) and rarely by general neurologists (1%). The majority of patients (94%) were counseled at two of six sites. Aim 1. Frequent counselors had greater years of clinical experience (24 vs. 16, p<0.05), and trend towards higher proportion of associate professors/professors (63% vs. 29%,p<0.10). Aim 2. Predictors of SUDEP counseling included physician factors: adult practice (OR = 1.74, 95% CI = 1.08-2.79), epilepsy training (4.38, 1.05-18.31), >