Abstracts

Many patients with epilepsy are treated by a primary care physician or a general neurologist. Some patients receive their care through emergency room (ER) visits where they are taken after seizures occur in the presence of others. This study was done to determine the characteristics of these patients., We obtained data of patients seen in the ER for seizures in 2002 and 2003, in two institutions, Vanderbilt University Hospital (VUH) and Metro Nashville General Hospital (MNGH), seeking to identify patients who had visited the emergency room more than once. The latter institution is a city hospital and largely serves the underprevilaged population. We also collected insurance information of these patients, and compared them to the outpatient VUH epilepsy clinic data., The authors identified 702 patients visiting the VUH emergency room and 446 the MNGH emergency room for seizures. Among these 125 (18%) and 157 (35%) had visited the room more than once. Others may have also visited other emergency rooms, but this information was not available. The mean ER patient age at VUH was 24 years and at MNGH was 40 years and the mean number of visits was 2.66 and 3.7. The proportion of patients coming to the ER more that once for seizures was 1.8 times higher in the MNGH than the VUH ER. The insurance distribution in the VUH epilepsy clinic was: Medicaid 14%, Medicare 11%, self-pay 1%, commercial insurance and Blue Cross 70%. The insurance distribution in the VUH ER was: Medicaid 49%, Medicare 11%, self-pay 7%, commercial insurance and Blue Cross 32%. The insurance distribution in the MNGH ER was: Medicaid 38%, Medicare 12%, self-pay 36%, commercial insurance 0.9%., A considerable number of patients with epilepsy visit the emergency room repeatedly for their epilepsy care. The proportion of seizure patients with recurrent visits to the emergency room for seizures is higher in the City Hospital. By virtue of its demogaraphics, it is representative of the care provided for the underserved. The insurance distribution amongst patients also suggests that the ER seizure population has a greater representation of Medicaid and self-pay patients, who are likely of low socioeconomic status. Under or un-insured (self-pay), patients are significantly higher in numbers at the city Hospital. Therefore pointing to disparity of care, leading to management of a chronic ailment like epilepsy through the ER, which is unlikely to be the appropriate means for management and may be a cause for improper care at greater expense.,