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Professionals in Epilepsy Care Symposium: Access to Epilepsy Care
Across the Spectrum December 7, 2013 Janelle L. Wagner, PhD
Medical University of South Carolina
American Epilepsy Society | Annual Meeting
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Professionals in Epilepsy Care Symposium: Access to Epilepsy Care
Across the Spectrum December 7, 2013 Janelle L. Wagner, PhD
Medical University of South Carolina
American Epilepsy Society | Annual Meeting
Disclosure
Name of Commercial Interest
None
American Epilepsy Society | 2013 Annual Meeting
Type of Financial Relationship
Learning Objectives
•Recognize and explicitly address cultural barriers to managing care for persons with epilepsy
•Provide care for children and youth with epilepsy by utilizing medical home and telemedicine
•Collaborate with patient in developing, utilizing, and maintaining self-management skills for psychiatric comorbidities and psychosocial challenges or recognize the need to refer patient to mental health professional
American Epilepsy Society | 2013 Annual Meeting
Institute of Medicine Report
•Charge to the epilepsy community to improve: •Access to care •Prevention and treatment of epilepsy •Prevention and treatment of the comorbidities of epilepsy , quality of life and health related outcomes
•http://www.iom.edu/Reports/2012/Epilepsy-Across-the-Spectrum.aspx. Epilepsy across the spectrum: promoting health and understanding. Institute of Medicine of the National Academies; 2012.
American Epilepsy Society | 2013 Annual Meeting
Access to Care: IOM Report
•Low SES •> ED visits and > hospitalization rates •50% less likely to take AEDs
•Racial and ethnic minorities •AA more likely to use ED for epilepsy care & less likely to have surgery •AA and Hispanics had lower rates of epilepsy visits to specialists
•Children •Greater difficulties for children with Medicaid to access neurologists •Wait time of 53 days to see a child neurologist
•Challenges to improving access to care •Timely, adequate care •By the appropriate health care and human service providers
American Epilepsy Society | 2013 Annual Meeting
Comorbidities
• Up to 50% of persons with epilepsy have psychiatric, developmental, and/or cognitive comorbidities.
•(Jensen, Epilepsia. 2011;52, 1-6)
•Depression is the most frequent comorbidity. •(Kanner et al., Epilepsy & Beh. 2012; 24, 156-168)
•Persons with epilepsy and a psychiatric comorbidity report poorer quality of life, experience more AED side effects and more seizures, and report more unmet physical and mental health care needs.
•(Baca et al., Pediatrics. 2011; 128, e1532-e1543; Kanner et al., Epilepsy & Beh. 2012; 24, 156-168; Kanner et al., Epilepsia. 2012; 53, 1104-1108; Russ et al., Pediatrics. 2012; 129, 256-264; )
American Epilepsy Society | 2013 Annual Meeting
American Epilepsy Society | 2013 Annual Meeting
EPILEPSY AS A SPECTRUM DISORDER
Case Example
•Adolescent female •Focal epilepsy, medically uncontrolled •Symptoms of depression •Medicaid •Lives in western, rural Colorado •Mother speaks solely Spanish •Mother can't bring her to hospital for EMU evaluation
•Distance, weather •No child care for other children •Wages lost
Access to Epilepsy Care Across the Spectrum
•Epidemiologic Research- Dr. David Thurman
•Cultural Considerations- Dr. Lisa Andermann
•Advocacy- Phil Gattone
•Pediatric Care- Dr. Jan Buelow
•Medical Home and Telemedicine- Linda Fletcher
•Adult Mental Health- Dr. Nancy Thompson