Abstracts

Rationale: There is a disparity between wealthy and limited resources regions in access to medical treatment. The reasons of treatment gap are heterogeneous, one could due to lack of diagnosis. Our previous study in Brazil showed a life time prevalence of epilepsy of approximately 1% and treatment gap to be around 40%. This work aims to ascertain the diagnosis gap of epilepsy in primary care setting in Brazil.Methods: We used an official database of the Department of Primary Care attention of Ministry of Health as most people in Brazil rely on public health system, named SUS (Unified Health System). We used population census dataset from IBGE (Brazilian Institute of Geography and Statistics) and assumed 1% as lifetime prevalence of epilepsy. There are three ways to assess diagnosis gap based on the official data of the Ministry of Health is combined with the Census information. The first type of diagnosis gap is estimated considering an ideal SUS coverage of a 100%. The two others are based on the coverage provided by Communitarian Agents or by the Family Physician Program. The diagnostic gap considering a 100% SUS coverage is defined as the difference between estimated prevalence and number of people with epilepsy in the official registry, divided by estimated prevalence, then expressed in percentage. On the other hand, for two distinct existent SUS coverage, we calculated the diagnosis gap as the difference between the estimated prevalence of epilepsy on the population of the specific coverage analyzed and the number of people with epilepsy in the official registry, divided by estimated prevalence of epilepsy on the population of the specific coverage analyzed.Results: The mean diagnosis gap in Brazil is 87% when considering an ideal SUS coverage of 100%. In this case, each of the five macro regions showed the following percentages; North (90%); Northeast (84%), Center-West (86%), Southeast (90%) and South (87%). The mean diagnosis gap in Brazil changed to 80% when considering the estimated number of people that are reached by Communitarian Agents (63% coverage). In this case, each of the five macro regions expressed the following percentages: North (88%); Northeast (82%), Center-West (79%), Southeast (78%) and South (77%). When considering the number of estimated people reached by the Family Physician Program (52% coverage), the mean diagnosis gap changed to 76%. In this case, the diagnosis gap percentages found in each macro region were: North (81%); Northeast (78%), Center-West (74%), Southeast (75%) and South (75%).Conclusions: The Brazilian Primary Care offers free of charge the four basic anti-epileptic drugs. However, the diagnosis gap is probably one of the major problems that stand between the treatment and the people who need it. These results show the magnitude of this problem is high regardless of the region or the type of primary care model (Family Physician or Communitarian Agents). People with epilepsy in Brazil are invisible for the public health care system. Public policies aiming to increase the diagnosis of epilepsy should take place to decrease the treatment gap.