Targeting Social Determinants to Improve Epilepsy Outcomes: Findings from the IMPACT Epilepsy Provider Survey
Abstract number :
3.516
Submission category :
17. Public Health
Year :
2024
Submission ID :
1591
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Meredith Olenec, BA, CHW – Dartmouth Hitchcock Medical Center
Anny Reyes, PhD – Cleveland Clinic
Jonathan Williams, MD – Washington University School of Medicine
Elizabeth Felton, MD, PhD – University of Wisconsin-Madison
Farah Lubin, PhD – University of Alabama at Birmingham
Tracee Mason, MA – Florida A&M University
Temitayo Oyegbile-Chidi, MD, PhD – University of California, Davis
Bruce Hermann, PhD – University of Wisconsin
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth-Hitchcock Medical Center
Rationale: Health disparities in epilepsy are significant and multifaceted, often driven by social determinants of health (SDOH) such as socioeconomic status (SE), education, access to care, and cultural stigma. Individuals from lower socioeconomic, rural, or marginalized communities are less likely to receive specialized epilepsy care, leading to worse health outcomes, including higher seizure frequency, complications (e.g., death), and neurobehavioral comorbidities. To better understand and address these health disparities, the IMPACT (Initiatives for Mobilizing Equitable Patient Access, Care, and Treatment) Epilepsy committee was developed. Our first initiative was to survey epilepsy providers’ perception of the most common SDOH impacting epilepsy care.
Methods: Development of the provider survey was guided by an expert panel of multidisciplinary epilepsy center clinicians, scientists and public health researchers. Survey questions were clustered into key thematic areas to elucidate top access, patient-level, and cost-related barriers affecting epilepsy care. Face and content validity were established, and surveys were delivered electronically via REDCap. Data analysis was descriptive.The survey was distributed through various organizational networks in epilepsy and related fields.
Results: Most respondents (n=82) were epileptologists, neuropsychologists, or neurologists (Table 1). Practice settings included urban and rural, with fewer suburban and safety net providers. The top three access-related barriers were transportation, rural setting, and specialty care (i.e., epilepsy care); Figure 1. The top three patient-level barriers were behavioral and mental health needs, social support, and patient health literacy and education levels. The top three cost-related barrierswere financial stability, insurance coverage (private vs public health insurance), and medication coverage. Providers endorsed patient-level barriers as the most common barrier impacting epilepsy care. Of the providers surveyed, 42.7% reported screening for SDOH 'all the time,' while 52.4% indicated that they address SDOH 'some of the time.' Providers reported that SDOH most frequently impacts patient access to medical treatment (92.7%), medication adherence (85.4%), and access to surgical treatment (79.3%).
Conclusions: Preliminary survey findings highlight provider feedback that suggests access-related, patient-level, and cost-related barriers, such as transportation challenges, mental health needs, and financial instability, are prevalent and contribute to inequities in epilepsy treatment and outcomes. Providers identified patient-level barriers as the most impactful, emphasizing the need for targeted patient-centered interventions to address behavioral health, social support, and health literacy among individuals living with epilepsy. A need for standardized identification and addressing of SDOH in epilepsy care settings emerged through these preliminary data. The IMPACT Epilepsy initiative will continue to explore how SDOH contribute to health disparities in epilepsy, guiding the development of actionable strategies to reduce these disparities.
Funding: N/A
Public Health