Frequency and factors associated with emergency department attendance for people with epilepsy in a rural UK population

Allard, Jon; Shankar, Rohit; Henley, William; Brown, Andrew R.; McLean, Brendan; Jadav, Mark; Parrett, Mary; Laugharne, Richard; Noble, Adam; Ridsdale, Leone

doi:10.1016/j.yebeh.2017.01.017

Cited by 14 publications

(7 citation statements)

References 19 publications

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“…Based on responses to prior health DCEs89 and studies with PWE,16 24 we anticipate 30%–60% of those invited will agree to participate. An average English GP practice90 will have 24 PWE aged ≥18 on their register who have experienced ≥1 seizure in the prior 12 months,9 with 10 having visited an ED during that period 12–14. Governed by the need to recruit a subgroup of 174 PWE who have visited ED in the prior 12 months, 29–58 general practices will be required.…”

Section: Methods and Analysismentioning

confidence: 99%

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Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational ‘Collaborate’ project

et al. 2019

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IntroductionEmergency department (ED) visits for epilepsy are common, costly, often clinically unnecessary and typically lead to little benefit for epilepsy management. An ‘Alternative Care Pathway’ (ACP) for epilepsy, which diverts people with epilepsy (PWE) away from ED when ‘999’ is called and leads to care elsewhere, might generate savings and facilitate improved ambulatory care. It is unknown though what features it should incorporate to make it acceptable to persons from this particularly vulnerable target population. It also needs to be National Health Service (NHS) feasible. This project seeks to identify the optimal ACP configuration.Methods and analysisMixed-methods project comprising three-linked stages. In Stage 1, NHS bodies will be surveyed on ACPs they are considering and semi-structured interviews with PWE and their carers will explore attributes of care important to them and their concerns and expectations regarding ACPs. In Stage 2, Discrete Choice Experiments (DCE) will be completed with PWE and carers to identify the relative importance placed on different care attributes under common seizure scenarios and the trade-offs people are willing to make. The uptake of different ACP configurations will be estimated. In Stage 3, two Knowledge Exchange workshops using a nominal group technique will be run. NHS managers, health professionals, commissioners and patient and carer representatives will discuss DCE results and form a consensus on which ACP configuration best meets users’ needs and is NHS feasible.Ethics and disseminationEthical approval: NRES Committee (19/WM/0012) and King’s College London ethics Committee (LRS-18/19-10353). Primary output will be identification of optimal ACP configuration which should be prioritised for implementation and evaluation. A pro-active dissemination strategy will make those considering developing or supporting an epilepsy ACP aware of the project and opportunities to take part in it. It will also ensure they are informed of its findings.Project registration numberResearchregistry4723.

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Section: Methods and Analysismentioning

confidence: 99%

“…Annually, ≤20% of people with epilepsy (PWE) visit hospital ED 4–6. They report more anxiety, seizures and perceived epilepsy stigma than those in the wider epilepsy population and live in more deprived areas7–12; ~20% have an intellectual disability 13 14…”

Section: Introductionmentioning

confidence: 99%

Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational ‘Collaborate’ project

et al. 2019

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“…Ten reports included information on the context of seizures in the ED; including reasons for repeated attendance and the views of people with epilepsy [6][7][8][12][13][14][15][16][17][18].…”

Section: The Current Context Of Ed Attendance For Seizuresmentioning

confidence: 99%

“…Both studies found a third of the study population attending ED three or more times and accounting for over two third of the total yearly ED visits many unnecessary. Attendance reasons varied around demographic and clinical factors [14] such as depression [15], anxiety [7] quality of life [8,15,16], seizure frequency [7], lower social deprivation [5,9], stigma [8,15], low levels of medication self-management [8], high seizure frequency [8,16], polytherapy and co-morbidities [7]. Some reports had contrasting findings, with one finding that epilepsy knowledge, medication management and stigma were not concerns in rural areas [7] as suggested by a study in an urban area [8] raising the possibility of possible demographic differences in perceived needs between rural and urban populations.…”

Section: The Current Context Of Ed Attendance For Seizuresmentioning

confidence: 99%

“…Seizure freedom rates in the UK are around 50 % [5] leading to 40,000 hospital admissions and a further 60,000 attendances at ED within England (ED) [6]. A significant minority are repeat attendees: around one third of them account for 2/3 of the attendances [7,8]. Recommendations in the UK are that people with epilepsy are reviewed yearly by either a general physician or a specialist [3]; However in April 2014 epilepsy was no longer included in quality outcomes frameworks T for primary care in the UK thus putting this recommendation at risk of compliance [9].…”

Section: Introductionmentioning

confidence: 99%

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Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review

Burrows

Lennard

Hudson

et al. 2020

Seizure

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Background: Repeat attendances to emergency departments for seizures, impacts on the individual and burdens health care systems. We conducted a review to identify implementable measures which improve the management of people with epilepsy reducing healthcare costs and their supportive evidence. Methods: A scoping review design using suitable search strategy as outlined by PRISMA-ScR was used to examine seven databases: MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, HMIC and BNI. A manual search of the COCHRANE database and citation searching was also conducted. A thematic analysis was conducted to explore the context and reasons of emergency department attendance for seizures, particularly repeat attendances and the strategies and measures deployed to reduce repeat attendances. Results: Twenty-nine reports were included, comprising of a systematic review, a randomised control study, a multi-method study, quantitative studies (n = 17), qualitative studies (n = 6), an audit, a survey and a quality improvement project. Thematic analysis identified four broad areas for reducing repeat attendances. These were developing care pathways, conducting care and treatment reviews, providing educational interventions and role of ambulance staff. Conclusion: The findings indicate varied reasons for attendance at ED following seizure, including mental health and knowledge of seizure management and lack of education. Implementations of care pathways in ED have been found to reduce admission related costs.

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Seizures and emergency department: characteristics and factors of repeat adult attendees

et al. 2022

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Frequency and factors associated with emergency department attendance for people with epilepsy in a rural UK population

Cited by 14 publications

References 19 publications

Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational ‘Collaborate’ project

Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational ‘Collaborate’ project

Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review

Seizures and emergency department: characteristics and factors of repeat adult attendees

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