The Path to Equity: A Regional Needs Assessment of Clinicians Caring for People with Epilepsy in Northern New England
Abstract number :
2.408
Submission category :
17. Public Health
Year :
2023
Submission ID :
1028
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Edward Camp, BA – HOBSCOTCH Institute, Dartmouth Health
Marcy Doyle, DNP, MHS, MS, RN, CNL – University of New Hampshire Institute for Health Policy and Practice; Jeanne Ryer, MSc, EdD – University of New Hampshire Institute for Health Policy and Practice; Barbara Jobst, MD-PhD, FAES, FAAN – Geisel School of Medicine at Dartmouth College; Carly Sykes, MPH – HOBSCOTCH Institute, Dartmouth Health; Elaine Kiriakopoulos, MD, MSc – Geisel School of Medicine at Dartmouth College
Rationale:
In the United States, 3.4 million people have active epilepsy and an estimated 29,600 adults and 3,900 children have epilepsy in New Hampshire, Maine, and Vermont. Even when seizures are well controlled, challenges often persist, leading to increased morbidity, mortality, and decreased quality of life. The consequences of epilepsy are exacerbated by substantial disparities in access to neurologic specialty care. Rural and underserved communities are especially at risk for barriers to care. This study aimed to elucidate gaps in knowledge, confidence, and practice that clinicians in Northern New England (NNE) providing care to people with epilepsy (PWE) experience.
Methods:
We conducted a cross-sectional study collecting quantitative digital survey data between 10/2022 and 02/2023. We invited multilevel, multidisciplinary clinical providers (Table 1A) to participate if they met the following criteria: (1) representative of a clinical provider working directly with PWE; or (2) employed in a position involving services related to PWE. We examined key clinical domains of diagnosis, treatment, referral, patient education and counseling, evidence-based epilepsy self-management and social determinants of health (SDOH) needs and the ability to link to community supports. Frequencies on all closed-ended digital survey items were computed. Correlations between clinician knowledge and confidence were determined using Spearman’s rank correlation. Data were analyzed in SAS 9.3 (SAS Institute, Cary NC) and the R programming language (R Core Team, 2021).
Results:
We analyzed clinician (n=80) self-reported knowledge across three subgroups by credential: physicians (MD/DO), advanced practice providers (APP; APRN, NP, PA), and nursing (RN/LPN). Of total clinician respondents 97.5% cared for people with low socioeconomic status, and 95.1% cared for patients residing in rural areas. 82.5% of clinicians indicated that PWE made up less than 10% of their practice volume. We examined data for correlation between self-reported knowledge and self-reported confidence and found them to be strongly correlated (Spearman's rank correlation coefficient (rho) was calculated to be 0.904 for MD/DO subgroup, 0.689 for APP subgroup, and 0.845 for RN/LPN subgroup). Across clinical groups, knowledge gaps were identified for all clinician subgroups in each of the key clinical care domains with differences in mean self-reported knowledge in Figures 2A-D.
Conclusions:
Analysis reveals a significant knowledge and confidence gap around diagnosis and treatment of epilepsy, evidence-based treatment guidelines, self-management, SDOH impacts, and pointedly a low knowledge level around the treatment of medication-resistant epilepsy, which given the risks augments, concern. Education and training opportunities for clinicians are necessary to ensure equitable access to quality care and support for PWE in NNE. Interventions that provide enabling factors for guidelines-based care and decision support, which propels coordination of care with epilepsy specialists, are warranted.
Funding: N/A
Public Health