Abstracts

Rationale: A major barrier for epilepsy patients living in rural areas is the ability to access specialist care regularly. Epileptologists from The University of Arizona travel to the Hopi Health Care Center (HHCC), an IHS hospital in Northern Arizona, for one day every three months. Transportation, weather, and scheduling problems limit the number of HHCC epilepsy patients seen by the visiting neurologists during those rare occasions. Such barriers to reasonable access impose restrictions on the ability of the specialist to provide regular quality care and hamper patients ability to self manage their epilepsy, adding to the increased risk of poor physical and mental health, poor psychosocial function, and diminished quality of life. These challenges faced by both specialists and patients under such conditions only serve to alter the clinical consultation from a regular check-up to a stressful and condensed consultation. The goal of this project is to determine the feasibility of improving continuity of epilepsy care through tele-epilepsy by determining whether patients are satisfied with the telemedicine experiences and whether patients in this minority group are accepting of telemedicine as a form of consultation. Methods: Patients identified as having epilepsy by the HHCC were approached by their community health representatives (CHRs) and informed about the study and asked to participate. Informed consent was obtained by the CHRs. Demographic information and the Quality of Life in Epilepsy (QOLIE-31) questionnaires were obtained prior to the initial tele-epilepsy consultation visit. The CHRs at the HHCC scheduled telemedicine consultations within 3 months and then every 3 to 6 months afterwards. After each telemedicine encounter a 9 item Visit Specific Satisfaction Questionnaire (VSQ 9) was completed. In the second six months of the study, 20% of patients and their caregivers were invited to take part in an interview via telephone or in person to explore further the benefits and drawbacks of having additional epilepsy related telemedicine services as well as the process itself. (IRB approval obtained through University of Arizona & Phoenix Area Indian Health Services.) Results: To date, a total of 13 patients have been recruited for the study. The tele-epilepsy consultations have been well received by the Hopi patients who view the experience as novel and interesting. Overall they do not feel that the experience is impersonal and feel that the quality of care that they receive via the tele-epilepsy experience is equal to that of the in person clinic visit. Conclusions: The patients viewed the telemedicine experience as an acceptable and reasonable supplement or replacement to the in person visits, and reported satisfaction with the epilepsy related care. Patients showed a willingness to participate in future telemedicine clinics and expressed satisfaction with the use of the telemedicine approach demonstrating that tele-epilepsy services on the Indian reservation are a feasible and acceptable option. (Supported by a grant from the National EpiFellows Foundation to Kendra Drake, MD.)