| Description |
Background: Drug Resistant Epilepsy (DRE) occurs when two adequate trials of tolerated and appropriately chosen anti-seizure drugs fail to control seizures, and is associated with excess morbidity and mortality. Surgical treatment of DRE is one of the most underutilized evidence-based therapeutic interventions, and for patients who undergo surgery, the average time from onset to referral is 22 years. Little evidence exists regarding provider knowledge levels of DRE, the use of clinical guidelines to refer patients for surgery, or barriers to referring patients with DRE to a Comprehensive Epilepsy Center (CEC).Methods: A Quality Improvement (QI) project was developed to improve neurologist's and Primary Care Provider (PCP)'s knowledge and referral practice of patients with DRE to a CEC. Neurologists and PCPs at an urban Utah hospital received an educational presentation through PowerPoint either in person or online. The presentation included the definition of DRE, epidemiology of DRE, treatment options for DRE, surgical options for DRE, benefits of surgery, and a care pathway algorithm for the treatment and referral of DRE. Prior to the educational presentation, the respondents completed a survey to assess their knowledge levels regarding DRE, its treatment, when to refer patients with DRE to a CEC, and their perceived barriers to referring patients with DRE to a CEC. Following the educational presentation, the respondents completed a post-survey to determine the effectiveness of the educational presentation. Results: Among the 34 pre-survey respondents, 56% were able to correctly identify the definition of DRE, 50% were able to correctly identify the percent of epileptic patients that have DRE, while 56% were unable to correctly identify the percentage of patients with DRE who have focal epilepsy. Fifty-seven percent of respondents were unable to correctly identify when a PCP should refer a patient with DRE to a specialist, and the majority were not able to correctly identify when a neurologist should refer patients with DRE to a CEC. Sixty-six percent of respondents were aware of clinical guidelines for the treatment of DRE, and 86% were willing to change their referral practice based on the guideline's recommendations. Among the 17 post-survey respondents, 82% were able to correctly identify the definition of DRE, 76% were able to correctly identify the percent of epileptic patients that have DRE, while 59% were unable to correctly identify the percentage of patients with DRE who have focal epilepsy. Seventy-one percent of respondents were able to correctly identify when a PCP should refer a patient with DRE to a specialist, while 53% were unable to identify when a neurologist should refer patients with DRE to a CEC. The majority of respondents were aware of clinical guidelines for the treatment of DRE (88%), and 82% were willing to change their referral practice based on the guideline's recommendations.Conclusions: While respondent knowledge levels increased after the educational presentation, none of the findings were statistically significant. Future research is warranted to utilize the Theory of Planned Behavior (TPB) to better understand providers' intentions to use clinical guidelines to change their referral practice |
