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ALKhaldi NA, Tu M, Suller Marti A, Zafar A, Le C, Debicki D, Mirsattari SM. Management of patients with epilepsy and Intellectual disabilities in group homes vs. Family Homes: Insights into polypharmacy and seizure characteristics. Epilepsy Behav 2024; 152:109639. [PMID: 38295506 DOI: 10.1016/j.yebeh.2024.109639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES This study aimed to investigate the differences in ASMs prescription, seizure characteristics and predictors of polypharmacy in patients with epilepsy and Intellectual disabilities (IDs) residing in group homes versus family homes. METHODS This nine-year retrospective study analyzed patients with epilepsy and IDs who were admitted to the EMU, epilepsy clinics at LHSC and rehabilitation clinics for patients with IDs at Parkwood Institution. The study included individuals aged 16 years and older residing in either group homes or family homes. Data on demographics, epilepsy characteristics, and ASMs use were collected and analyzed using the Statistical Package for Social Sciences. The study utilized binary logistic regression to identify predictors of polypharmacy in patients with epilepsy and IDs. RESULTS The study enrolled a total of 81 patients, of which 59.3 % resided in family homes. Group home residents were significantly older (41 vs. 24.5 years; p = 0.0001) and were prescribed more ASMs (3 vs. 2; p = 0.002). Specific ASMs were more common in group homes, including valproic acid (54.5 % vs. 25.0 %), lacosamide (54.5 % vs. 22.9 %), topiramate (33.3 % vs. 14.6 %), and phenytoin (30.3 % vs. 6.2 %). Admission to the EMU was more prevalent in group homes (93.9 % vs. 52.1 %; p = 0.0001). Living in a group home increased the risk of polypharmacy (OR = 10.293, p = 0.005), as did older epilepsy onset age (OR = 1.135, p = 0.031) and generalized or focal & generalized epilepsy (OR = 7.153, p = 0.032 and OR = 10.442, p = 0.025, respectively). SIGNIFICANCE Our study identified notable differences in the demographic and clinical characteristics of patients with epilepsy and IDs living in group homes versus family homes. Age of epilepsy onset, EMU admissions, epilepsy types, and residency setting were significant predictors of polypharmacy. These findings highlight the need for personalized care strategies and increased awareness of the potential risks associated with polypharmacy.
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Affiliation(s)
- Norah A ALKhaldi
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia.
| | - Michelle Tu
- Department of Psychology, Western University, London, Ontario, Canada
| | - Ana Suller Marti
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Azra Zafar
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Christine Le
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Division of Neurology, St. Josephs Health Centre, Toronto, Canada
| | - Derek Debicki
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Seyed M Mirsattari
- Department of Psychology, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Michaelis R, Tang V, Nevitt SJ, Wagner JL, Modi AC, LaFrance WC, Goldstein LH, Gandy M, Bresnahan R, Valente K, Donald KA, Reuber M. Psychological treatments for people with epilepsy. Cochrane Database Syst Rev 2020; 8:CD012081. [PMID: 35653266 PMCID: PMC8409429 DOI: 10.1002/14651858.cd012081.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Given the significant impact epilepsy may have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is increasing clinical interest in evidence-based psychological treatments, aimed at enhancing psychological and seizure-related outcomes for this group. This is an updated version of the original Cochrane Review published in Issue 10, 2017. OBJECTIVES To assess the impact of psychological treatments for people with epilepsy on HRQOL outcomes. SEARCH METHODS For this update, we searched the following databases on 12 August 2019, without language restrictions: Cochrane Register of Studies (CRS Web), which includes randomized or quasi-randomized controlled trials from the Specialized Registers of Cochrane Review Groups including Epilepsy, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to 09 August 2019), and PsycINFO (EBSCOhost, 1887 onwards), and from PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP). We screened the references from included studies and relevant reviews, and contacted researchers in the field for unpublished studies. SELECTION CRITERIA We considered randomized controlled trials (RCTs) and quasi-RCTs for this review. HRQOL was the main outcome. For the operational definition of 'psychological treatments', we included a broad range of skills-based psychological treatments and education-only interventions designed to improve HRQOL, seizure frequency and severity, as well as psychiatric and behavioral health comorbidities for adults and children with epilepsy. These psychological treatments were compared to treatment as usual (TAU), an active control group (such as social support group), or antidepressant pharmacotherapy. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 36 completed RCTs, with a total of 3526 participants. Of these studies, 27 investigated skills-based psychological interventions. The remaining nine studies were education-only interventions. Six studies investigated interventions for children and adolescents, three studies investigated interventions for adolescents and adults, and the remaining studies investigated interventions for adults. Based on satisfactory clinical and methodological homogeneity, we pooled data from 11 studies (643 participants) that used the Quality of Life in Epilepsy-31 (QOLIE-31) or other QOLIE inventories (such as QOLIE-89 or QOLIE-31-P) convertible to QOLIE-31. We found significant mean changes for the QOLIE-31 total score and six subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication effects, and cognitive functioning). The mean changes in the QOLIE-31 total score (mean improvement of 5.23 points, 95% CI 3.02 to 7.44; P < 0.001), and the overall QoL score (mean improvement of 5.95 points, 95% CI 3.05 to 8.85; P < 0.001) exceeded the threshold of minimally important change (MIC: total score: 4.73 points; QoL score: 5.22 points), indicating a clinically meaningful postintervention improvement in HRQOL. We downgraded the certainty of the evidence provided by the meta-analysis due to serious risks of bias in some of the included studies. Consequently, these results provided moderate-certainty evidence that psychological treatments for adults with epilepsy may enhance overall HRQOL. AUTHORS' CONCLUSIONS Implications for practice: Skills-based psychological interventions improve HRQOL in adults and adolescents with epilepsy. Adjunctive use of skills-based psychological treatments for adults and adolescents with epilepsy may provide additional benefits in HRQOL when these are incorporated into patient-centered management. We judge the evidence to be of moderate certainty. IMPLICATIONS FOR RESEARCH Investigators should strictly adhere to the CONSORT guidelines to improve the quality of reporting on their interventions. A thorough description of intervention protocols is necessary to ensure reproducibility. When examining the effectiveness of psychological treatments for people with epilepsy, the use of standardized HRQOL inventories, such as the Quality of Life in Epilepsy Inventories (QOLIE-31, QOLIE-31-P, and QOLIE-89) would increase comparability. Unfortunately, there is a critical gap in pediatric RCTs and RCTs including people with epilepsy and intellectual disabilities. Finally, in order to increase the overall quality of RCT study designs, adequate randomization with allocation concealment and blinded outcome assessment should be pursued. As attrition is often high in research that requires active participation, an intention-to-treat analysis should be carried out. Treatment fidelity and treatment competence should also be assessed. These important dimensions, which are related to 'Risk of bias' assessment, should always be reported.
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Affiliation(s)
- Rosa Michaelis
- Department of Neurology Gemeinschaftskrankenhaus Herdecke, University of Witten/Herdecke, Herdecke, Germany
| | - Venus Tang
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hospital Authority, Hong Kong
- Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong
| | - Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Janelle L Wagner
- College of Nursing, Medical University of South Carolina, Charleston, USA
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - William Curt LaFrance
- Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Milena Gandy
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Rebecca Bresnahan
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kette Valente
- Faculty of Medicine, University of São Paulo (HCFMUSP), Sao Paulo, Brazil
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
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Higgins A, Murphy R, Downes C, Varley J, Begley C, Elliott N. Factors influencing the implementation of Epilepsy Specialist Nurse role: Using the Consolidation Framework for Implementation Research. J Clin Nurs 2020; 29:1352-1364. [PMID: 31972049 DOI: 10.1111/jocn.15197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/20/2019] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice. AIM To describe the enabling and inhibiting factors to the implementation of the Epilepsy Specialist Nurse role in the Republic of Ireland. METHODS A qualitative design involving semi-structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 Epilepsy Specialist Nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigour is demonstrated using the COREQ checklist (See Appendix S1). RESULTS While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports and competence of Epilepsy Specialist Nurses. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost-saving measure, also emerged as potential barriers to future sustainability. CONCLUSION The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries. RELEVANCE TO CLINICAL PRACTICE In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability and sustainability of services provided.
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Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Murphy
- ALL Institute, Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jarlath Varley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Naomi Elliott
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Pennington M, Ring H, Howlett J, Smith C, Redley M, Murphy C, Hook R, Platt A, Gilbert N, Jones E, Kelly J, Pullen A, Mander A, Donaldson C, Rowe S, Wason J, Irvine F. The impact of an epilepsy nurse competency framework on the costs of supporting adults with epilepsy and intellectual disability: findings from the EpAID study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1391-1400. [PMID: 31397022 PMCID: PMC7613974 DOI: 10.1111/jir.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The development of a nurse-led approach to managing epilepsy in adults with an intellectual disability (ID) offers the potential of improved outcomes and lower costs of care. We undertook a cluster randomised trial to assess the impact on costs and outcomes of the provision of ID nurses working to a designated epilepsy nurse competency framework. Here, we report the impact of the intervention on costs. METHOD Across the United Kingdom, eight sites randomly allocated to the intervention recruited 184 participants and nine sites allocated to treatment as usual recruited 128 participants. Cost and outcome data were collected mainly by telephone interview at baseline and after 6 months. Total costs at 6 months were compared from the perspective of health and social services and society, with adjustments for pre-specified participant and cluster characteristics at baseline including costs. Missing data were imputed using multiple imputation. Uncertainty was quantified by bootstrapping. RESULTS The intervention was associated with lower per participant costs from a health and social services perspective of -£357 (2014/2015 GBP) (95% confidence interval -£986, £294) and from a societal perspective of -£631 (95% confidence interval -£1473, £181). Results were not sensitive to the exclusion of accommodation costs. CONCLUSIONS Our findings suggest that the competency framework is unlikely to increase the cost of caring for people with epilepsy and ID and may reduce costs.
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Affiliation(s)
- M Pennington
- Department of Health Services and Population Research, King's Health Economics, PO24, David Goldberg Centre, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - H Ring
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK
| | - J Howlett
- MRC Biostatistics Unit, University of Cambridge, Institute of Public Health, Cambridge, UK
| | - C Smith
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - M Redley
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - C Murphy
- King's Clinical Trials Unit, PO64 Institute of Psychiatry, King's College London, London, UK
| | - R Hook
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A Platt
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - N Gilbert
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - E Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - J Kelly
- King's Clinical Trials Unit, PO64 Institute of Psychiatry, King's College London, London, UK
| | - A Pullen
- Epilepsy Action, New Antsey House, Leeds, UK
- NHS Leeds West Clinical Commissioning Group, Leeds, UK
| | - A Mander
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK
| | - C Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - S Rowe
- Finance and Contracts, NHS Wakefield Clinical Commissioning Group, Wakefield, UK
| | - J Wason
- MRC Biostatistics Unit, University of Cambridge, Institute of Public Health, Cambridge, UK
| | - F Irvine
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Ring H, Howlett J, Pennington M, Smith C, Redley M, Murphy C, Hook R, Platt A, Gilbert N, Jones E, Kelly J, Pullen A, Mander A, Donaldson C, Rowe S, Wason J, Irvine F. Training nurses in a competency framework to support adults with epilepsy and intellectual disability: the EpAID cluster RCT. Health Technol Assess 2019; 22:1-104. [PMID: 29457585 DOI: 10.3310/hta22100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND People with an intellectual (learning) disability (ID) and epilepsy have an increased seizure frequency, higher frequencies of multiple antiepileptic drug (AED) use and side effects, higher treatment costs, higher mortality rates and more behavioural problems than the rest of the population with epilepsy. The introduction of nurse-led care may lead to improvements in outcome for those with an ID and epilepsy; however, this has not been tested in a definitive clinical trial. OBJECTIVE To determine whether or not ID nurses, using a competency framework developed to optimise nurse management of epilepsy in people with an ID, can cost-effectively improve clinical and quality-of-life outcomes in the management of epilepsy compared with treatment as usual. DESIGN Cluster-randomised two-arm trial. SETTING Community-based secondary care delivered by members of community ID teams. PARTICIPANTS Participants were adults aged 18-65 years with an ID and epilepsy under the care of a community ID team and had had at least one seizure in the 6 months before the trial. INTERVENTIONS The experimental intervention was the Learning Disability Epilepsy Specialist Nurse Competency Framework. This provides guidelines describing a structure and goals to support the delivery of epilepsy care and management by ID-trained nurses. MAIN OUTCOME MEASURES The primary outcome was the seizure severity scale from the Epilepsy and Learning Disabilities Quality of Life questionnaire. Measures of mood, behaviour, AED side effects and carer strain were also collected. A cost-utility analysis was undertaken along with a qualitative examination of carers' views of participants' epilepsy management. RESULTS In total, 312 individuals were recruited into the study from 17 research clusters. Using an intention-to-treat analysis controlling for baseline individual-level and cluster-level variables there was no significant difference in seizure severity score between the two arms. Altogether, 238 complete cases were included in the non-imputed primary analysis. Analyses of the secondary outcomes revealed no significant differences between arms. A planned subgroup analysis identified a significant interaction between treatment arm and level of ID. There was a suggestion in those with mild to moderate ID that the competency framework may be associated with a small reduction in concerns over seizure severity (standard error 2.005, 95% confidence interval -0.554 to 7.307; p = 0.092). However, neither subgroup showed a significant intervention effect individually. Family members' perceptions of nurses' management depended on the professional status of the nurses, regardless of trial arm. Economic analysis suggested that the competency framework intervention was likely to be cost-effective, primarily because of a reduction in the costs of supporting participants compared with treatment as usual. LIMITATIONS The intervention could not be delivered blinded. Treatment as usual varied widely between the research sites. CONCLUSIONS Overall, for adults with an ID and epilepsy, the framework conferred no clinical benefit compared with usual treatment. The economic analysis suggested that there may be a role for the framework in enhancing the cost-effectiveness of support for people with epilepsy and an ID. Future research could explore the specific value of the competency framework for those with a mild to moderate ID and the potential for greater long-term benefits arising from the continuing professional development element of the framework. TRIAL REGISTRATION Current Controlled Trials ISRCTN96895428. FUNDING This trial was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Howard Ring
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK
| | - James Howlett
- Medical Research Council (MRC) Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Mark Pennington
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Marcus Redley
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, Institute of Psychiatry, King's College London, London, UK
| | - Roxanne Hook
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Adam Platt
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Nakita Gilbert
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Elizabeth Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Joanna Kelly
- King's Clinical Trials Unit, Institute of Psychiatry, King's College London, London, UK
| | - Angela Pullen
- Epilepsy Action, Leeds, UK.,NHS Leeds West Clinical Commissioning Group, Leeds, UK
| | - Adrian Mander
- Medical Research Council (MRC) Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Simon Rowe
- NHS Wakefield Clinical Commissioning Group, Wakefield, UK
| | - James Wason
- King's Clinical Trials Unit, Institute of Psychiatry, King's College London, London, UK
| | - Fiona Irvine
- School of Health and Population Science, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Nishina Y, Yoshioka SI. A Survey of Epilepsy-related Knowledge, Attitudes and Practices of Home Healthcare Nurses in the San-in Region of Japan. Yonago Acta Med 2018. [PMID: 29599618 DOI: 10.33160/yam.2018.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Comprehensive care is necessary for people with epilepsy (PWE) to lead a fulfilling life at home and in the community. The purpose of this study was to determine the epilepsy-related knowledge, attitudes and practices of home healthcare nurses (HHNs) in the San-in region of Japan. Methods A questionnaire survey was conducted by mail of 546 HHNs working in Tottori and Shimane Prefectures. The questionnaire assessed the epilepsy-related knowledge, attitudes and practices of HHNs. For the analysis, simple and cross tabulation of questionnaire responses were conducted, and the chi-squared test was used for statistical testing. Results A total of 285 HHNs participated in the study. Of the respondents, 43.9% had experience taking care of PWE in a home healthcare nursing setting. Regarding the cause of epilepsy, in descending order the percentage of correct responses were 86.7% for stroke, 85.3% for head injury, and only 13.3% for dementia. Concerning how to respond to an epileptic seizure, almost all respondents answered correctly, but 29.8% gave the incorrect answer of "place something inside the mouth." Regarding the practices of HHNs in relation to caring for PWE, nurses scored 52.0% for collaborating with the attending physician, indicating the need for improvement. The score for "provide information about social resources" was low at 18.4%. Of the respondents, 95.8% answered that epilepsy-related knowledge and technical skills were necessary for home healthcare nursing practice, and 87.7% were interested in participating in a workshop on epilepsy. Conclusion The study revealed an inadequate level of knowledge of epilepsy with dementia and corresponding epileptic seizures, a low awareness of nursing care in collaboration with physicians, and the importance of providing information about social resources. There is a need to offer information and education on the latest knowledge about epilepsy to HHNs.
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Affiliation(s)
- Yuko Nishina
- Department of Nursing Care Environment and Mental Health, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Shin-Ichi Yoshioka
- Department of Nursing Care Environment and Mental Health, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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Yennadiou H, Wolverson E. The experience of epilepsy in later life: A qualitative exploration of illness representations. Epilepsy Behav 2017; 70:87-93. [PMID: 28411521 DOI: 10.1016/j.yebeh.2017.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/08/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study was to explore how older people living with epilepsy appraise their condition through their lived-experience. The common-sense model of illness representations (CSMIR) provides a framework to explain how individuals make sense of and manage health threats. Semi-structured in-depth interviews based on the CSMIR were conducted with ten people with epilepsy who were above the age of 65. The results were analyzed using Interpretative Phenomenological Analysis. Three overarching themes emerged from the analysis: 'the power of epilepsy', 'they say you can live a normal life but you can't' and 'attempts to adjust and cope'. Epilepsy was described as a threatening, persistent, and unpredictable condition associated with distressing experiences. Participants described a process of balancing negative psychosocial consequences including stigma, loss of control, and reliance on other people and medication with parallel co-existing coping strategies. These attempts to manage the condition were characterized by a desire for acceptance and increased awareness of epilepsy, strategies to restore loss of control, and strength derived from supportive relationships. We conclude that there is large scope for psychosocial interventions in healthcare provision for this patient group. The roles of specialist nursing, relationship-centered models, psychotherapy, educational, and self-management programs are highlighted.
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Affiliation(s)
- Haris Yennadiou
- The University of Hull, Faculty of Health and Social Care, Aire Building, Hull, Cottingham Road, Hull HU6 7RX, UK.
| | - Emma Wolverson
- The University of Hull, Faculty of Health and Social Care, Aire Building, Hull, Cottingham Road, Hull HU6 7RX, UK.
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Ring H, Gilbert N, Hook R, Platt A, Smith C, Irvine F, Donaldson C, Jones E, Kelly J, Mander A, Murphy C, Pennington M, Pullen A, Redley M, Rowe S, Wason J. Improving outcomes in adults with epilepsy and intellectual disability (EpAID) using a nurse-led intervention: study protocol for a cluster randomised controlled trial. Trials 2016; 17:297. [PMID: 27342377 PMCID: PMC4919880 DOI: 10.1186/s13063-016-1429-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 05/11/2016] [Indexed: 11/26/2022] Open
Abstract
Background In adults with intellectual disability (ID) and epilepsy there are suggestions that improvements in management may follow introduction of epilepsy nurse-led care. However, this has not been tested in a definitive clinical trial and results cannot be generalised from general population studies as epilepsy tends to be more severe and to involve additional clinical comorbidities in adults with ID. This trial investigates whether nurses with expertise in epilepsy and ID, working proactively to a clinically defined role, can improve clinical and quality of life outcomes in the management of epilepsy within this population, compared to treatment as usual. The trial also aims to establish whether any perceived benefits represent good value for money. Methods/design The EpAID clinical trial is a two-arm cluster randomised controlled trial of nurse-led epilepsy management versus treatment as usual. This trial aims to obtain follow-up data from 320 participants with ID and drug-resistant epilepsy. Participants are randomly assigned either to a ‘treatment as usual’ control or a ‘defined epilepsy nurse role’ active arm, according to the cluster site at which they are treated. The active intervention utilises the recently developed Learning Disability Epilepsy Specialist Nurse Competency Framework for adults with ID. Participants undergo 4 weeks of baseline data collection, followed by a minimum of 20 weeks intervention (novel treatment or treatment as usual), followed by 4 weeks of follow-up data collection. The primary outcome is seizure severity, including associated injuries and the level of distress manifest by the patient in the preceding 4 weeks. Secondary outcomes include cost-utility analysis, carer strain, seizure frequency and side effects. Descriptive measures include demographic and clinical descriptors of participants and clinical services in which they receive their epilepsy management. Qualitative study of clinical interactions and semi-structured interviews with clinicians and participants’ carers are also undertaken. Discussion The EpAID clinical trial is the first cluster randomised controlled trial to test possible benefits of a nurse-led intervention in adults with epilepsy and ID. This research will have important implications for ID and epilepsy services. The challenges of undertaking such a trial in this population, and the approaches to meeting these are discussed. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN96895428 version 1.1. Registered on 26 March 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1429-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Howard Ring
- Department of Psychiatry, University of Cambridge, Douglas House, 18d Trumpington Road, Cambridge, CB2 8AH, UK. .,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. .,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK.
| | - Nakita Gilbert
- Department of Psychiatry, University of Cambridge, Douglas House, 18d Trumpington Road, Cambridge, CB2 8AH, UK
| | - Roxanne Hook
- Department of Psychiatry, University of Cambridge, Douglas House, 18d Trumpington Road, Cambridge, CB2 8AH, UK
| | - Adam Platt
- Department of Psychiatry, University of Cambridge, Douglas House, 18d Trumpington Road, Cambridge, CB2 8AH, UK
| | - Christopher Smith
- Department of Psychiatry, University of Cambridge, Douglas House, 18d Trumpington Road, Cambridge, CB2 8AH, UK
| | - Fiona Irvine
- School of Health and Population Science, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Elizabeth Jones
- Department of Psychiatry, University of Cambridge, Douglas House, 18d Trumpington Road, Cambridge, CB2 8AH, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK
| | - Joanna Kelly
- King's Clinical Trials Unit, PO64 Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Adrian Mander
- MRC Biostatistics Unit Hub for Trials Methodology Research, Institute of Public Health, Robinson Way, Cambridge, CB2 0SR, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, PO64 Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Mark Pennington
- Kings Health Economics, PO24, David Goldberg Centre, Institute of Psychiatry Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, UK
| | - Angela Pullen
- Epilepsy Action, New Antsey House, Gate Way Drive, Yeadon, Leeds, LS19 7XY, UK.,NHS Leeds West Clinical Commissioning Group, Suites 2-4, Wira House, Wira Business Park, Leeds, LS16 6EB, UK
| | - Marcus Redley
- Department of Psychiatry, University of Cambridge, Douglas House, 18d Trumpington Road, Cambridge, CB2 8AH, UK.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK
| | - Simon Rowe
- NHS Wakefield Clinical Commissioning Group, White Rose House, West Parade, Wakefield, West Yorkshire, WF1 1LT, UK
| | - James Wason
- King's Clinical Trials Unit, PO64 Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK
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9
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Abstract
BACKGROUND Researchers have criticised epilepsy care for adults for its lack of impact, stimulating the development of various service models and strategies to respond to perceived inadequacies. OBJECTIVES To assess the effects of any specialised or dedicated intervention beyond that of usual care in adults with epilepsy. SEARCH METHODS For the latest update of this review, we searched the Cochrane Epilepsy Group Specialized Register (9 December 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 11), MEDLINE (1946 to June 2013), EMBASE (1988 to June 2013), PsycINFO (1887 to December 2013) and CINAHL (1937 to December 2013). In addition, we contacted experts in the field to seek information on unpublished and ongoing studies, checked the websites of epilepsy organisations and checked the reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials, controlled or matched trials, cohort studies or other prospective studies with a control group, and time series studies. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted all data, and assessed the quality of all included studies. MAIN RESULTS Our review included 18 different studies of 16 separate interventions, which we classified into seven distinct groups. Most of the studies have methodological weaknesses, and many results from other analyses within studies need to be interpreted with caution because of study limitations. Consequently, there is currently limited evidence for the effectiveness of interventions to improve the health and quality of life in people with epilepsy. It was not possible to combine study results in a meta-analysis because of the heterogeneity of outcomes, study populations, interventions and time scales across the studies. AUTHORS' CONCLUSIONS Two intervention types, the specialist epilepsy nurse and self management education, have some evidence of benefit. However, we did not find clear evidence that other service models substantially improve outcomes for adults with epilepsy. It is also possible that benefits are situation specific and may not apply to other settings. These studies included only a small number of service providers whose individual competence or expertise may have had a significant impact on outcomes. At present it is not possible to advocate any single model of service provision.
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Affiliation(s)
| | - Bruce Lindsay
- University of East AngliaSchool of Nursing and Midwifery, Faculty of HealthEdith Cavell BuildingNorwichNorfolkUKNR7 4TJ
| | - Nigel Fleeman
- University of LiverpoolLiverpool Reviews & Implementation Group2nd Floor, Sherrington BuildingsAshton StreetLiverpoolUKL69 3GE
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10
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Tsiachristas A, Wallenburg I, Bond CM, Elliot RF, Busse R, van Exel J, Rutten-van Mölken MP, de Bont A. Costs and effects of new professional roles: Evidence from a literature review. Health Policy 2015; 119:1176-87. [PMID: 25899880 DOI: 10.1016/j.healthpol.2015.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
One way in which governments are seeking to improve the efficiency of the health care sector is by redesigning health services to contain labour costs. The aim of this study was to investigate the impact of new professional roles on a wide range of health service outcomes and costs. A systematic literature review was performed by searching in different databases for evaluation papers of new professional roles (published 1985-2013). The PRISMA checklist was used to conduct and report the systematic literature review and the EPHPP-Quality Assessment Tool to assess the quality of the studies. Forty-one studies of specialist nurses (SNs) and advanced nurse practitioners (ANPs) were selected for data extraction and analysis. The 25 SN studies evaluated most often quality of life (10 studies), clinical outcomes (8), and costs (8). Significant advantages were seen most frequently regarding health care utilization (in 3 of 3 studies), patient information (5 of 6), and patient satisfaction (4 of 6). The 16 ANP studies evaluated most often patient satisfaction (8), clinical outcomes (5), and costs (5). Significant advantages were seen most frequently regarding clinical outcomes (5 of 5), patient information (3 of 4), and patient satisfaction (5 of 8). Promoting new professional roles may help improve health care delivery and possibly contain costs. Exploring the optimal skill-mix deserves further attention from health care professionals, researchers and policy makers.
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Affiliation(s)
- A Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.
| | - I Wallenburg
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - C M Bond
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - R F Elliot
- Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland, UK
| | - R Busse
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
| | - J van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M P Rutten-van Mölken
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - A de Bont
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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11
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Noble AJ, McCrone P, Seed PT, Goldstein LH, Ridsdale L. Clinical- and cost-effectiveness of a nurse led self-management intervention to reduce emergency visits by people with epilepsy. PLoS One 2014; 9:e90789. [PMID: 24603669 PMCID: PMC3948384 DOI: 10.1371/journal.pone.0090789] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 02/03/2014] [Indexed: 11/18/2022] Open
Abstract
People with chronic epilepsy (PWE) often make costly, and clinically unnecessary emergency department (ED) visits. Some do it frequently. No studies have examined interventions to reduce them. An intervention delivered by an epilepsy nurse specialist (ENS) might reduce visits. The rationale is it may optimize patients' self-management skills and knowledge of appropriate ED use. We examined such an intervention's clinical- and cost-effectiveness. Eighty-five adults with epilepsy were recruited from three London EDs with similar catchment populations. Forty-one PWE recruited from two EDs received treatment-as-usual (TAU) and formed the comparison group. The remaining 44 PWE were recruited from the ED of a hospital that had implemented a new ENS service for PWE attending ED. These participants formed the intervention group. They were offered 2 one-to-one sessions with an ENS, plus TAU. Participants completed questionnaires on health service use and psychosocial well-being at baseline, 6- and 12-month follow-up. Covariates were identified and adjustments made. Sixty-nine (81%) participants were retained at follow-up. No significant effect of the intervention on ED visits at 12 months or on other outcomes was found. However, due to less time as inpatients, the average service cost for intervention participants over follow-up was less than for TAU participants' (adjusted difference £558, 95% CI, -£2409, £648). Covariates most predictive of subsequent ED visits were patients' baseline feelings of stigmatization due to epilepsy and low confidence in managing epilepsy. The intervention did not lead to a reduction in ED use, but did not cost more, partly because those receiving the intervention had shorter hospital admissions. Our findings on long-term ED predictors clarifies what causes ED use, and suggests that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency-savings generated.
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Affiliation(s)
- Adam J. Noble
- Department of Psychological Sciences, Institute of Psychology, Health & Society, University of Liverpool/Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, United Kingdom
| | - Paul McCrone
- Health Service and Population Research, Institute of Psychiatry, King's College London, London United Kingdom
| | - Paul T. Seed
- Division of Women's Health, King's College London, London, United Kingdom
| | - Laura H. Goldstein
- Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Leone Ridsdale
- Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, London, United Kingdom
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12
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Wiebe N, Fiest KM, Dykeman J, Liu X, Jette N, Patten S, Wiebe S. Patient satisfaction with care in epilepsy: How much do we know? Epilepsia 2014; 55:448-55. [DOI: 10.1111/epi.12537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Natalie Wiebe
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Faculty of Nursing; University of Calgary; Calgary Alberta Canada
| | - Kirsten M. Fiest
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Departments of Clinical Neurosciences and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
- Department of Psychiatry; University of Calgary; Calgary Alberta Canada
| | - Jonathan Dykeman
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
| | - Xiaorong Liu
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Departments of Clinical Neurosciences and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University; Guangzhou China
| | - Nathalie Jette
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Departments of Clinical Neurosciences and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
| | - Scott Patten
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Department of Psychiatry; University of Calgary; Calgary Alberta Canada
| | - Samuel Wiebe
- Clinical Research Unit; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences and Institute for Public Health; University of Calgary; Calgary Alberta Canada
- Departments of Clinical Neurosciences and Hotchkiss Brain Institute; University of Calgary; Calgary Alberta Canada
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13
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Ridsdale L, McCrone P, Morgan M, Goldstein L, Seed P, Noble A. Can an epilepsy nurse specialist-led self-management intervention reduce attendance at emergency departments and promote well-being for people with severe epilepsy? A non-randomised trial with a nested qualitative phase. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ObjectivesTo (1) describe the characteristics and service use of people with established epilepsy (PWE) who attend the emergency department (ED); (2) evaluate the economic impact of PWE who attend the ED; (3) determine the effectiveness and cost-effectiveness of an epilepsy nurse specialist (ENS)-led self-management intervention plus treatment as usual (TAU) compared with TAU alone in reducing ED use and promoting well-being; (4) describe patients' views of the intervention; and (5) explore their reasons for attending the ED.DesignNon-randomised trial with nested qualitative study.SettingThe EDs of three inner London hospitals. The EDs each offer similar services and support a similar local population, which made a comparison of patient outcomes reasonable.ParticipantsAdults diagnosed with epilepsy for ≥ 1 year were prospectively identified from the EDs by presenting symptom/discharge diagnosis. We recruited 85 of 315 patients with 44 forming the intervention group and 41 the comparison group.InterventionIntervention participants were offered two one-to-one outpatient sessions delivered by an ENS who aimed to optimise self-management skills and knowledge of appropriate emergency service use. The first session lasted for 45–60 minutes and the second for 30 minutes.Main outcome measuresThe primary outcome was the number of ED visits that participants reported making over the 6 months preceding the 12-month follow-up. Secondary outcomes were visits reported at the 6-month follow-up and scores on psychosocial measures.ResultsIn the year preceding recruitment, the 85 participants together made 270 ED visits. The frequency of their visits was positively skewed, with 61% having attended multiple times. The mean number of visits per participant was 3.1 [standard deviation (SD) 3.6] and the median was two (interquartile range 1–4). Mean patient service cost was £2355 (SD £2455). Compared with findings in the general epilepsy population, participants experienced more seizures and had greater anxiety, lower epilepsy knowledge and greater perceived stigma. Their outpatient care was, however, consistent with National Institute for Health and Clinical Excellence recommendations. In total, 81% of participants were retained at the 6- and 12-month follow-ups, and 80% of participants offered the intervention attended. Using intention-to-treat analyses, including those adjusted for baseline differences, we found no significant effect of the intervention on ED use at the 6-month follow-up [adjusted incidence rate ratio (IRR) 1.75, 95% confidence interval (CI) 0.93 to 3.28] or the 12-month follow-up (adjusted IRR 1.92, 95% CI 0.68 to 5.41), nor on any psychosocial outcomes. Because they spent less time as inpatients, however, the average service cost of intervention participants over follow-up was less than that of TAU participants (adjusted difference £558, 95% CI –£2409 to £648). Lower confidence in managing epilepsy and more felt stigma at baseline best predicted more ED visits over follow-up. Interviews revealed that patients generally attended because they had no family, friend or colleague nearby who had the confidence to manage a seizure. Most participants receiving the intervention valued it, including being given information on epilepsy and an opportunity to talk about their feelings. Those reporting most ED use at baseline perceived the most benefit.ConclusionsAt baseline, > 60% of participants who had attended an ED in the previous year had reattended in the same year. In total, 50% of their health service costs were accounted for by ED use and admissions. Low confidence in their ability to manage their epilepsy and a greater sense of stigma predicted frequent attendance. The intervention did not lead to a reduction in ED use but did not cost more, partly because those receiving the intervention had shorter average hospital stays. The most common reason reported by PWE for attending an ED was the lack of someone nearby with sufficient experience of managing a seizure. Those who attended an ED frequently and received the intervention were more likely to report that the intervention helped them. Our findings on predictors of ED use clarify what causes ED use and suggest that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency savings generated.Trial registrationCurrent Controlled Trials ISRCTN06469947.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 1, No. 9. See the HSDR programme website for further project information.
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Affiliation(s)
- L Ridsdale
- Institute of Psychiatry, King's College London, London, UK
| | - P McCrone
- Institute of Psychiatry, King's College London, London, UK
| | - M Morgan
- Institute of Psychiatry, King's College London, London, UK
| | - L Goldstein
- Institute of Psychiatry, King's College London, London, UK
| | - P Seed
- Division for Women's Health, King's College London, London, UK
| | - A Noble
- Institute of Psychiatry, King's College London, London, UK
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14
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Hopkins J, Irvine F. Qualitative insights into the role and practice of Epilepsy Specialist Nurses in England: a focus group study. J Adv Nurs 2012; 68:2443-53. [PMID: 22332948 DOI: 10.1111/j.1365-2648.2012.05941.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM This article is a report of a study that aimed to explore Epilepsy Specialist Nurses' perceptions of their professional role and the factors that may affect their practice. BACKGROUND Previous studies have demonstrated high patient satisfaction with the Epilepsy Specialist Nurse. Although UK national guidelines recommend that all individuals with epilepsy should have access to an epilepsy specialist nurse, many National Health Service trusts disregard these guidelines. The need to introduce cost efficiencies in the National Health Service means that the future of some epilepsy specialist nurses is threatened. DESIGN A qualitative study using focus groups was designed to elicit a rich understanding of the epilepsy specialist nurse role and its current challenges. METHODS Three focus groups were held with a total of 19 participants in the summer of 2009. Data were subjected to thematic framework analysis. FINDINGS The work was underpinned by high commitment to nursing values, which helped to define the role. Epilepsy specialist nurses were often the sole providers of expert and personalized care to meet patients' complex needs. Policy and financially driven changes undermined professional identity and led to service diminution. CONCLUSION . The provision of epilepsy care in England remains variable and access to epilepsy specialist nurses is inequitable. Trusts are being seduced by the cost savings of reducing a specialist service but consequent gaps in service may drive up costs elsewhere. The challenge is for epilepsy specialist nurses to demonstrate their unique place in enhancing patient care and in improving health and well-being.
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Affiliation(s)
- Jan Hopkins
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
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15
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Lua PL, Neni WS. Awareness, knowledge, and attitudes with respect to epilepsy: an investigation in relation to health-related quality of life within a Malaysian setting. Epilepsy Behav 2011; 21:248-54. [PMID: 21576038 DOI: 10.1016/j.yebeh.2011.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/27/2011] [Accepted: 03/30/2011] [Indexed: 11/28/2022]
Abstract
The influence of awareness, knowledge, and attitudes (AKA) on the health-related quality of life (HRQoL) of patients with epilepsy has not been widely established. The aims of this preliminary study were to (1) assess general AKA and HRQoL levels, (2) correlate AKA and HRQoL levels, and (3) compare the HRQoL of patients with epilepsy with different AKA levels. A cross-sectional sample of outpatients with epilepsy were recruited from the Neurology Clinic, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia. Data analysis was carried out using the Statistical Package for Social Sciences Version 15 employing descriptive and nonparametric statistics. On written consent, included patients completed the Malay AKA Epilepsy and the Malay Quality of Life in Epilepsy-30 (MQOLIE-30) instruments. Across all patients, both AKA levels (median: 80.0, range: 0-170) and overall HRQoL (median 51.5; range 15-97) were moderate. Awareness was significantly correlated only with Seizure Worry (r(s)=+0.29, p<0.05), whereas Knowledge was not significantly linked to any domain. However, Attitudes was significantly correlated with all domains (r(s)=+0.35 to +0.47, p<0.01) except Medication Effects and Seizure Worry. Patients with good AKA levels (Total Score ≥ median) experienced significantly better Overall Quality of Life and Cognitive Functioning (p<0.05). Findings showed that AKA may play an important role in influencing patients' HRQoL, suggesting that epilepsy treatment efforts should also focus on enhancing AKA through epilepsy awareness to improve health outcomes.
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Affiliation(s)
- Pei Lin Lua
- Centre for Clinical and Quality of Life Studies, Faculty of Medicine and Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia.
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16
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Kirton JA, Jack BA, O’Brien MR, Roe B. Care of patients with neurological conditions: the impact of a Generic Neurology Nursing Service development on patients and their carers. J Clin Nurs 2011; 21:207-15. [DOI: 10.1111/j.1365-2702.2010.03684.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Al-Aqeel S, Al-Sabhan J. Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy. Cochrane Database Syst Rev 2011:CD008312. [PMID: 21249705 DOI: 10.1002/14651858.cd008312.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Poor adherence to antiepileptic medications is associated with increased mortality and morbidity. In this review we focus on interventions designed to assist patients with adherence to antiepileptic medications. OBJECTIVES To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medications in adults and children with epilepsy. SEARCH STRATEGY We searched the Epilepsy Group's Specialised Register (24 June 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2) and electronic databases: MEDLINE (OVID) (1950 to June 2010); EMBASE (OVID) (1980 to 2010 Week 24); CINAHL (1982 to June 2010) and PsycINFO (22 June 2010), and the reference lists of relevant articles. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of adherence-enhancing interventions aimed at patients with clinical diagnosis of epilepsy (as defined in individual studies), of any age and of either gender, treated with antiepileptic drugs in a primary care, outpatient or other community setting. DATA COLLECTION AND ANALYSIS We screened titles and abstracts for eligibility. Two review authors independently extracted data and assessed each study according to the Cochrane criteria. The studies differed widely according to intervention and measures of adherence, therefore combining data was not appropriate. MAIN RESULTS Six trials met our inclusion criteria: five targeted adult epileptic patients with a combined patient number of 222 and one targeted parents of children with epilepsy (n = 51). Follow-up time was generally short: from one to six months. Two main types of intervention were examined: educational and behavioural modification. Each study compared treatment with no intervention 'usual care'. None compared one intervention with another. Due to heterogeneity between studies in terms of interventions and the methods used to measure adherence, we did not pool the results. Education and counselling of patients with epilepsy have shown mixed success. Behavioural interventions such as the use of intensive reminders and 'implementation intention' interventions provided more positive effects on adherence. AUTHORS' CONCLUSIONS Intensive reminders and 'implementation intention' interventions appear promising in enhancing adherence to antiepileptic mediations, however we need more reliable evidence on their efficacy from carefully designed randomised controlled trials before a firm conclusion can be reached.
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Affiliation(s)
- Sinaa Al-Aqeel
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
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18
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Abstract
BACKGROUND Epilepsy care has been criticised for its lack of impact. Various service models and strategies have been developed in response to perceived inadequacies in care provision. OBJECTIVES To compare the effectiveness of any specialised or dedicated intervention for the care of adults with epilepsy to the effectiveness of usual care. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE (1966 to May 2006), EMBASE (1988 to May 2006), PsychINFO (1806 to May 2006) and CINAHL (1982 to May 2006). SELECTION CRITERIA Randomised controlled trials, controlled or matched trials, cohort studies or other prospective studies with a control group, or time series studies. DATA COLLECTION AND ANALYSIS Each review author independently selected studies, extracted data and assessed the quality of included studies. MAIN RESULTS There are 13 trials and 16 reports included in this review. Seven distinct groups of interventions were identified: seven papers reported on five trials of specialist epilepsy nurses. Of the 13 trials, at least three (four reports) have methodological weaknesses, and some of the results from other analyses within studies need to be interpreted with caution because of limiting factors in the studies. Consequently, there is currently limited evidence for the effectiveness of interventions to improve the health and life quality of people with epilepsy. It was not possible to combine study results in a meta-analysis because of the heterogeneity of outcomes, study populations, interventions, and time scales across the studies. AUTHORS' CONCLUSIONS Two intervention types, the specialist epilepsy nurse and self-management education, have some evidence of benefit. However, we did not find clear evidence that other service models substantially improve outcomes for adults with epilepsy. It is also possible that benefits are situation specific and may not generalise to other settings. These studies included only a small number of service providers whose individual competence or expertise may have had a significant impact on outcomes. At present it is not possible to advocate any single model of service provision.
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Affiliation(s)
- P M Bradley
- Thingoe House, Cotton Lane, Bury St Edmonds, UK, IP33 1YJ.
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19
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Bradley PM, Lindsay B. WITHDRAWN: Specialist epilepsy nurses for treating epilepsy. Cochrane Database Syst Rev 2008; 2008:CD001907. [PMID: 18253997 PMCID: PMC10759271 DOI: 10.1002/14651858.cd001907.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Epilepsy is a common serious neurological condition with a 0.5% prevalence. As a result of the perceived deficiencies and suggestions to improve the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out-patient clinics (as opposed to the management of patients in general neurology clinics or general medical clinics) and nurse-based liaison services between primary (GP) and secondary/tertiary (hospital-based) care. OBJECTIVES To overview the evidence from controlled trials investigating the effectiveness of specialist epilepsy nurses compared to routine care. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (TheCochraneLibrary Issue 4, 2004), MEDLINE (October 2004), GEARS, EMBASE, ECRI, Effectiveness Healthcare Bulletin, Effectiveness Matters, Bandolier, Evidence Based Purchasing, National Research Register and PsycINFO databases. SELECTION CRITERIA Randomized controlled and quasi-randomized trials which considered specialist epilepsy nurse interventions with standard or alternative care were included in this review. DATA COLLECTION AND ANALYSIS Two reviewers independently selected trials for inclusion and extracted data. Outcomes investigated included: seizure frequency; appropriateness of medication prescribed; social or psychological functioning scores; knowledge about epilepsy scores; costs of care and adverse effects. MAIN RESULTS Three trials were included, two based in general practice and one in a neurology centre. The population of patients differed between trials, for example one study excluded patients with learning disabilities, and one only recruited patients with a new diagnosis. In view of this heterogeneity we decided not to pool results in a meta-analysis. As yet, there is no convincing evidence that specialist epilepsy nurses improve outcomes for people with epilepsy overall. Important outcomes (eg seizure frequency, psychosocial functioning, knowledge of epilepsy, general health status, work days lost, depression and anxiety scores) show no significant improvement. There is some evidence that people who have not had an epileptic seizure in the last six months are less at risk for depression. There is also evidence that newly diagnosed patients whose knowledge about epilepsy is poor may improve their epilepsy knowledge scores after nurse intervention. AUTHORS' CONCLUSIONS It is clearly plausible that specialist epilepsy nurses could improve quality in epilepsy care. However, there is as yet little evidence to support this assumption as the present research base is small. Further research is needed to investigate the effectiveness of specialist epilepsy nurses before such recommendations can be made.
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Affiliation(s)
- Peter M Bradley
- Thingoe HouseSuffolk West PCTCotton LaneBury St EdmondsUKIP33 1YJ
| | - Bruce Lindsay
- University of East AngliaSchool of Nursing and Midwifery, Faculty of HealthEdith Cavell BuildingNorwichNorfolkUKNR7 4TJ
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20
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Helde G, Bovim G, Bråthen G, Brodtkorb E. A structured, nurse-led intervention program improves quality of life in patients with epilepsy: a randomized, controlled trial. Epilepsy Behav 2005; 7:451-7. [PMID: 16087407 DOI: 10.1016/j.yebeh.2005.06.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 06/03/2005] [Accepted: 06/04/2005] [Indexed: 10/25/2022]
Abstract
We tested the hypothesis that structured epilepsy nursing improves quality of life (QOL). One hundred fourteen adult patients with uncontrolled epilepsy were randomly assigned to either an intervention group or a control group. The intervention group was offered an interactive, 1-day group education program followed by extended nurse follow-up and counseling. The nurse was present at as many outpatient consultations as possible and performed repeated consultations by telephone. All patients completed the QOLIE-89 before randomization and after 2 years. QOL was significantly improved from inclusion to completion of study in the intervention group (P=0.019), mainly in the subitems for Health Discouragement (P=0.01), Medication Effects (P=0.035), and Physical Role Limitations (P=0.05). To our knowledge, this is the first study to demonstrate a significant effect of a structured nurse-led intervention program in QOL of patients with epilepsy.
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Affiliation(s)
- Grethe Helde
- Department of Neuroscience, Faculty of Medicine, NTNU, N-7006 Trondheim, Norway.
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Stevenson FA, Cox K, Britten N, Dundar Y. A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expect 2004; 7:235-45. [PMID: 15327462 PMCID: PMC5060245 DOI: 10.1111/j.1369-7625.2004.00281.x] [Citation(s) in RCA: 278] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We draw on a systematic review of research on two-way communication between patients and health practitioners about medicines in order to determine the extent to which concordance is, or is not, being put into practice. DATA SOURCES Six electronic databases were searched using the following categories of search terms: health care professionals, patients/consumers, medicine-taking/prescribing and communication. Articles were also identified from handsearches of journals, article reference lists and the Concordance website. REVIEW METHODS Studies published between 1991 and 2000 were included. Studies were not excluded on the basis of design, methods or language employed. Abstracts of identified articles were assessed by at least two reviewers and the full articles were assessed by one reviewer and checked by at least one other reviewer. Data on the design, analysis and relevant findings were extracted. RESULTS A total of 11 801 abstracts were reviewed and 470 full articles were retrieved. Of the 134 articles subsequently included, 116 were descriptive studies. All but 10 of the papers were written in English. There were mixed findings about the extent to which patients feel that their beliefs, experience and preferences about medicines can be shared. Doctors tend to dominate discussions in consultations, although patient participation is associated with positive outcomes. Health care professionals' behaviour can impede as well as enhance patient involvement. CONCLUSIONS There is little research that examines fundamental issues for concordance such as whether an exchange of views takes place. It is possible that interventions are needed to facilitate the development of concordance in practice.
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Affiliation(s)
- Fiona A Stevenson
- Department of Primary Care and Population Sciences, Royal Free and University College School of Medicine, Hampstead, London, UK.
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Villeneuve N. Quelle organisation pour améliorer la qualité de la prise en charge des patients ayant une épilepsie partielle pharmaco-résistante ? Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vespignani H, Beaussart J, Ducrocq X, Maillard L. Éducation thérapeutique et information. Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71214-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mills N, Campbell R, Bachmann MO. What do patients want and get from a primary care epilepsy specialist nurse service? Seizure 2002; 11:176-83. [PMID: 12018961 DOI: 10.1053/seiz.2001.0615] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To assess what patients want and get from a primary care epilepsy specialist nurse service, and whether this matches their expectations and self-defined needs. METHODS A qualitative study nested within a controlled trial to evaluate the effectiveness of a primary care epilepsy specialist nurse service in Bristol, UK. Twelve patients who had had at least one seizure in the previous year were purposely selected from the trial population for an in-depth interview. Interviews were audiotape recorded and transcribed verbatim. Transcribed text was methodically coded and themes were identified using the method of constant comparison. RESULTS Not all informants wanted to see the epilepsy nurse as they felt their epilepsy was well controlled and thus they did not see the need for care or attention. Those that chose to use the nurse service did so as they wanted information on epilepsy or better control of their seizures. The epilepsy nurse was able to provide them with the information they wanted but was not able to improve their seizure control. Informants felt able to communicate effectively with the nurse and they valued the information and advice received. They were unable to get this kind of communication and empathy from other clinicians. Informants generally praised the nurse service but were aware that it was unlikely to improve the control of their seizures. Most accepted this. CONCLUSIONS Effective communication with clinicians is as much, if not more of a priority for patients with epilepsy, than is controlling the clinical manifestations of their condition.
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Affiliation(s)
- Nicola Mills
- Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK.
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Abstract
BACKGROUND Concern has been expressed over UK epilepsy service standards but the most clinically effective model of care is unknown. OBJECTIVE To systematically review the current evidence on specialist epilepsy clinics compared to general neurology clinics and specialist epilepsy nurses compared to usual care. METHODS Medline, Psychlit, Embase, Healthplan, GEARS, BIDS ISI, UKCHHO, international HTA websites, InterTASC databases and The Cochrane Library were searched to September 1999. Any studies comparing specialist epilepsy clinics or nurses to generalist services or usual care, reporting physical health, costs or generic quality-of-life outcomes were included. Two people independently applied inclusion and exclusion criteria and extracted data independently. Randomized controlled trial (RCT) quality was assessed by Jadad score and other studies qualitatively by the likelihood of bias. RESULTS Findings were one RCT and two other studies on epilepsy clinics and four RCTs and a controlled trial on epilepsy nurses. Data synthesis was inappropriate. Epilepsy clinics showed no evidence of reduced seizure frequency or severity, no quality-of-life information and were more expensive. Epilepsy nurse services showed no evidence of reduced seizure frequency or severity, no effect on quality-of-life but were less expensive. CONCLUSION There is insufficient evidence to demonstrate the superiority of any particular care model for producing better health outcomes.
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Affiliation(s)
- Catherine Meads
- Department of Public Health and Epidemiology, The University of Birmingham, Edgbaston, B15 2TT, UK
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Mills N, Campbell R, Bachmann MO. Professional and organizational obstacles to establishing a new specialist service in primary care: case study of an epilepsy specialist nurse. J Adv Nurs 2002; 37:43-51. [PMID: 11784397 DOI: 10.1046/j.1365-2648.2002.02062.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Few evaluations of the effectiveness of specialist nurse-led services explore the nurse's experiences, attitudes and qualities. This can help us to understand why a service has the effects it does and to inform new specialist nurses of potential difficulties. AIM To explore the experiences, feelings and perceived problems of providing a new specialist nurse service from the nurse's perspective. METHODS This was a case study nested within a controlled trial that assessed the effectiveness of an epilepsy specialist nurse-led service on the quality of patient care. In-depth interviews were conducted with the specialist nurse at the end of the first and second year of the new service. Interviews were audio-tape recorded and transcribed verbatim. Transcribed text was methodically coded and themes were identified. A descriptive account, summarizing the findings of both interviews, was written based on the thematic coding of text. RESULTS Overall, the epilepsy nurse felt a sense of achievement and believed that the service had had a beneficial impact on both patients and health care professionals in the locality. However, she experienced many operational problems, especially adapting to a primary care setting, difficulties in meeting practice staff and in motivating them, and contending with a heavy workload. These problems were partly attributable to her lack of community work experience and more generally to the structure of the service. CONCLUSIONS Findings indicate that specialist nurses responsible for providing primary care services would benefit from having theoretical knowledge and practical experience of working in the community prior to starting in post. The aims of a service need to be consistent with the available resources. Accounts of other specialist nurse's experiences of providing a primary care service could help to reduce set up time. Finally, support in the form of a coherent team is important to avoid feelings of professional isolation and to maximize effective use of specialist skills.
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Affiliation(s)
- Nicola Mills
- Department of Social Medicine, University of Bristol, Bristol, UK.
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Abstract
Epilepsy is a chronic condition with numerous social and psychological consequences. This work aimed to review available data on epilepsy and the impact of surgical and pharmaceutical treatments on the quality of life in adults and children. Research on quality of life in epilepsy is characterised by a wide and fragmentary range of methodology, both in terms of study design and instruments used. Quality of life is worse in patients with epilepsy than in the general population; it is comparable or worse in patients with epilepsy than that in patients with other chronic conditions; and it is similar to that of healthy persons when patients with epilepsy are well-controlled. Frequency of seizures seems to be one of the most relevant determinants of poor quality-of-life (QOL) scores, and quality of life is worsened by the co-existence of depression. The impact of surgical treatment on quality of life is positive, in all ages, in correlation with seizure control. There is no exhaustive or even contradictory results available concerning the impact of drug treatment. Role activities, emotional status and cognition have been the most investigated domains of quality of life in epilepsy research. There is a substantial lack of information regarding the functional status domain. At present, quality of life and psychosocial functioning in people with epilepsy have been investigated in many studies. Nevertheless, the lack of a standardised approach makes it extremely difficult to summarise and indicate what measures should be used, in which patients, and in which sub-populations. In the pursuit of developing valid, reliable and sensitive measures of quality of life, it seems no longer appropriate to consider seizure frequency alone.
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Couldridge L, Kendall S, March A. A systematic overview--a decade of research'. The information and counselling needs of people with epilepsy. Seizure 2001; 10:605-14. [PMID: 11792167 DOI: 10.1053/seiz.2001.0652] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This paper explores the background to epilepsy in terms of medical impact and psychosocial effects. The argument that information and counselling may be central to the person with epilepsy is explored. The evidence from primary research published between 1990 and 2000 investigating the information and counselling needs of people with epilepsy is appraised and synthesized. This paper seeks to answer the following questions: What are the information and counselling needs of people with epilepsy? What are the preferred formats, timing and delivery of information and counselling? What are the outcomes of information giving and counselling for people with epilepsy? The review suggests that there are unmet needs for personal and general information about epilepsy which may include individual or group education and counselling. Information related to gaining control for people with epilepsy and targeted public education may contribute to improved quality of life for people with epilepsy. Information is required which is individually relevant and could be delivered in small groups or as part of an individual counselling service. Specialist epilepsy clinics and specialist nurses can improve patient knowledge and communication and provide an effective and high quality service for people with epilepsy.
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Lambert MV, Bird JM. The assessment and management of adult patients with epilepsy--the role of general practitioners and the specialist services. Seizure 2001; 10:341-6. [PMID: 11488645 DOI: 10.1053/seiz.2001.0520] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Recommendations have been made that all patients developing seizures should be referred to specialist services for full investigation and assessment and re-referred for issues such as inadequate seizure control, consideration of drug withdrawal and for pre-conceptual counselling. Bristol area general practitioners (GPs) were sent a questionnaire to determine their referral practices for adult patients with epilepsy. Details of their current management of these patients and their requirements from the specialist services were also obtained. Questionnaires were completed and returned by 67.8% of the GPs. Most referred their patients to the neurological or neuropsychiatric services. More than 70% wanted their new patients to be assessed within 4 weeks. Approximately, half at least sometimes treated their patients before this assessment of which a third never or only rarely sought advice as to the most suitable anticonvulsant. Most (71.5%) believed they had consultations with their patients with epilepsy at least yearly; however, only 34.3% had a recall system for non-attendees. Two-thirds either currently audited their practices or were willing to consider doing so, and 64.4% recognized a need for regular seminars on epilepsy. Few welcomed the introduction of joint clinics but two thirds believed co-operation cards could be useful. GPs in practices with an epilepsy nurse specialist were more supportive of the use of co-operation cards and were more likely to be involved in audit. Recommendations to improve the care provided by the Primary Health Care teams and aid communications with the specialist epilepsy services are made.
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Affiliation(s)
- M V Lambert
- Department of Psychological Medicine, Section of Neuropsychiatry, Institute of Psychiatry and GKT Medical School, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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Abstract
BACKGROUND Epilepsy is the most common serious neurological condition after stroke, with a 0.5 per cent prevalence, and a two to three per cent life time risk of being given a diagnosis of epilepsy in the developed world. As a result of the perceived deficiencies and suggestions to improve the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out-patient clinics (as opposed to the management of patients in general neurology clinics or general medical clinics) and nurse-based liaison services between primary (GP) and secondary/tertiary (hospital based) care. OBJECTIVES The aim of this review is to overview the evidence from controlled trials investigating the effectiveness of specialist epilepsy nurses compared to routine care. SEARCH STRATEGY The following databases were searched: The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 1999), MEDLINE, GEARS, BIDS (EMBASE=Excepta Medica), ECRI, Effectiveness Healthcare Bulletin, Effectiveness Matters, Bandolier, Evidence Based Purchasing, National Research Register, Vignettes and expert panels from Standing Group on Health Technology Assessment, PsycLit database, World Wide Web sites and reference lists of articles. SELECTION CRITERIA All randomized controlled and quasi-randomized trials which considered specialist epilepsy nurse interventions with standard or alternative care were included in this review. DATA COLLECTION AND ANALYSIS Two reviewers independently selected trials for inclusion and extracted the relevant data. The following outcomes were assessed: (a) seizure frequency (b) appropriateness of medication prescribed (c) social or psychological functioning scores (d) knowledge about epilepsy scores (e) objective measures of general health status/quality of life (f) patients' reports of information received (g) number of days spent on sick leave/missing school and employment status (h) costs of care (i) adverse effects. MAIN RESULTS Three trials were included, two based in general practice and one in a neurology centre. The population of patients differed between trials, for example one study excluded patients with learning disabilities, and one only recruited patients with a new diagnosis. In view of this heterogeneity we decided not to pool results in a meta-analysis. As yet, there is no convincing evidence that specialist epilepsy nurses improve outcomes for people with epilepsy overall. Important outcomes (e.g. seizure frequency, psychosocial functioning, knowledge of epilepsy, general health status, work days lost, depression and anxiety scores) show no significant improvement. There is some evidence that those patients who have not had an epileptic seizure in the last six months are less at risk for depression. There is also evidence that newly diagnosed patients whose knowledge about epilepsy is poor may improve their epilepsy knowledge scores after nurse intervention. REVIEWER'S CONCLUSIONS It is clearly plausible that specialist epilepsy nurses could improve quality in epilepsy care. However, there is as yet little evidence to support this assumption as the present research base is small. Further research is needed to investigate the effectiveness of specialist epilepsy nurses before such recommendations can be made.
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Affiliation(s)
- P Bradley
- Health Prevention and Promotion, National Institute of Public Health Norway, Postbox 4044, Torshov 0403, Oslo, Norway.
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Foley J, Oates J, Mack C, Fox C. Improving the epilepsy service: the role of the specialist nurse. Seizure 2000; 9:36-42. [PMID: 10667961 DOI: 10.1053/seiz.1999.0365] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
There is currently a wide variation in the level of service provided for patients with epilepsy across the UK. Evidence is becoming available to suggest that improvements in local service provision may be achieved through the intervention of a specialist nurse. Using practical examples, this article explores the roles of the epilepsy specialist nurse, and examines how they may benefit patients and improve services. Functions such as liaison, patient assessment and management, counselling, provision of information, education, and audit are considered. It is hoped that the improved co-ordination and management of epilepsy services, that is achieved through specialist nurse intervention, will lead to improved patient outcomes and increased cost-effectiveness.
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Affiliation(s)
- J Foley
- Mill Lane Clinic, 5 Mill Lane, Edinburgh, EH6 6TJ, UK
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Mills N, Bachmann MO, Campbell R, Hine I, McGowan M. Effect of a primary care based epilepsy specialist nurse service on quality of care from the patients' perspective: results at two-years follow-up. Seizure 1999; 8:291-6. [PMID: 10486294 DOI: 10.1053/seiz.1999.0307] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Epilepsy specialist nurses have the potential to improve the quality of care of community-based patients with epilepsy, although evidence of their effectiveness is limited by the lack of formal or long-term evaluation. Results of a controlled trial that assessed the effectiveness of a primary care based specialist nurse-led service suggested improvements in communication and satisfaction but not health status at one-year follow-up. A second follow-up was conducted to assess the effects after two years. Patients who reported having seen the nurse at least once in the two years ('users') were compared with those who had not ('non-users'). Comparisons between users and non-users were adjusted for baseline differences. Results were based on 40% of all 595 adult patients known to have epilepsy in 14 general practices and who answered questionnaires at baseline and two years later. The new epilepsy service was used more by those with greatest needs for care. Users of the new service were significantly more likely than non-users to have discussed 8 of 11 topics asked about epilepsy [odds ratios (ORs) ranging from 2.42 to 7.91] with their general practitioner (GP), and 2 of the 11 topics with the hospital doctor (ORs 5.59, 5. 74). Service users were significantly less likely than non-users to feel their GP knew enough about epilepsy [OR 0.27, 95% confidence intervals (CI) 0.74-0.98], and significantly more likely to report epilepsy as having an adverse impact on 3 of 10 areas of everyday life (ORs ranging from 2.09 to 2.50). Users were more likely than non-users to have seen their GP for any reason in the previous year and to change their medication from use of more than one antiepileptic drug to monotherapy, although findings were not significant. Results suggest that the epilepsy specialist nurse service is not a cost-reducing substitute, particularly for general practitioner care, but it appears to improve communication and prescribing of monotherapy, and increases access for the most needy. The service may, however, have an adverse impact on patients' perceptions of the effects of epilepsy on aspects of everyday life.
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Affiliation(s)
- N Mills
- Department of Social Medicine, University of Bristol, Bristol, BS8 2PR, UK
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