What is the effect of delays in access to specialist epilepsy care on patient outcomes? A systematic review and meta-analysis

Lewis, Annie K.; Taylor, Nicholas F.; Carney, Patrick; Harding, Katherine E

doi:10.1016/j.yebeh.2021.108192

Cited by 15 publications

(13 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, delayed surgery has been shown recently to entail reduced chances of seizure and ASM freedom for all lesions, with the sole exception of hippocampal sclerosis, in a multicentric pediatric and adult cohort 24 . Furthermore, two meta‐analyses showed significant positive effects of early surgery on seizure freedom, including both epilepsy durations as short as 2 years and very long durations of up to 20 years, 73 and an average delay to surgery of 2.8 years less for seizure‐free patients compared to those with a less‐favorable outcome 74 . These data suggest that epileptogenic processes presenting with longer epilepsy duration decrease the chances of surgical success, independently of other predictors.…”

Section: Discussionmentioning

confidence: 94%

“…24 Furthermore, two meta-analyses showed significant positive effects of early surgery on seizure freedom, including both epilepsy durations as short as 2 years and very long durations of up to 20 years, 73 and an average delay to surgery of 2.8 years less for seizure-free patients compared to those with a less-favorable outcome. 74 These data suggest that epileptogenic processes presenting with longer epilepsy duration decrease the chances of surgical success, independently of other predictors. Based on this assumption, recent studies suggest recommending surgery very early in the course of the disease, even for non-drug-resistant patients.…”

Section: Worse Outcomes With Late Surgery (Frontal Temporal)mentioning

confidence: 90%

See 1 more Smart Citation

Timing of referral to evaluate for epilepsy surgery: Expert Consensus Recommendations from the Surgical Therapies Commission of the International League Against Epilepsy

et al. 2022

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Worse Outcomes With Late Surgery (Frontal Temporal)mentioning

confidence: 90%

Timing of referral to evaluate for epilepsy surgery: Expert Consensus Recommendations from the Surgical Therapies Commission of the International League Against Epilepsy

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Most epilepsy research has focused on the development of treatments and interventions, but few clinical trials have assessed service level interventions [3], and there have been few assessments of the process of care and related outcomes, and costs [4,5]. When doing so, it is important to consider the wider population, as it is possible that those outside specialist care have worse outcomes [6], which could be improved if ambulatory care was more accessible.…”

Section: Introductionmentioning

confidence: 99%

Care in Europe after presenting to the emergency department with a seizure; position paper and insights from the European Audit of Seizure Management in Hospitals

Taylor

Tudur-Smith

Dixon

et al. 2022

Euro J of Neurology

View full text Add to dashboard Cite

Background and purpose This position paper makes recommendations following an audit of care provided to people presenting with a seizure to emergency departments (EDs) in Europe. Methods Participating countries were asked to include five hospitals agreeing to identify 50 consecutive seizure patients presenting to their ED between 1 August 2016 and 31 August 2017. Anonymous data were collected to a web database. Where quoted, percentages are mean site values and ranges are the 10th–90th centile. Results Data were collected on 2204 ED visits (47 sites, up to six per country, across 15 countries): 1270 (58%) known epilepsy, 299 (14%) previous blackouts but no epilepsy diagnosis, 634 (29%) with a first seizure. Wide variability was identified for most variables. Of those with known epilepsy, 41.2% (range 26.2%–59.6%) attended the ED in the previous 12 months, but only 64.7% (range 37.2%–79.8%) had seen an epilepsy specialist in the previous 12 months. 67.7% (range 34.0%–100%) were admitted, 53.1% to a neurology ward (range 0.0%–88.9%). Only 37.5% first seizure patients (range 0.0%–71.4%) were given advice about driving. Conclusions and recommendations It is recommended that in Europe guidance is agreed on the management and onward referral of those presenting to the ED with a seizure; a referral process is created that can be easily implemented; it is ensured that the seizure services receive referrals and see the patients within a short time period; and a simple system is developed and implemented to allow continuous monitoring of key indices of epilepsy care.

show abstract

“…Previous research into the impact of delays in access to healthcare has focused on very specific patient populations and health conditions, using quantitative methods to seek associations between waiting time and specific health outcomes. [5][6][7][8] Such quantitative methods are limited by the outcomes chosen by researchers, and the findings are difficult to generalise to other areas of healthcare. The few studies that have investigated the experiences of consumers on waiting lists using qualitative methods have also focused on specific parts of the health system.…”

mentioning

confidence: 99%

‘I just need a plan’: Consumer perceptions of waiting for healthcare

Harding

Lewis

Taylor

2023

Evaluation Clinical Practice

Self Cite

View full text Add to dashboard Cite

RationaleWait lists are common in the provision of publicly funded services in outpatient and community settings.Aims and ObjectivesWe aimed to explore the experiences of consumers on wait lists across a broad range of services and to understand the impact of delays in access to services on people's lives.MethodsConsumers with experience of being on a wait list for an outpatient or community‐based health service participated in one of three focus groups. Data were transcribed and analysed inductively using a thematic approach.ResultsWaiting for healthcare has detrimental impacts on health and well‐being. Consumers on wait lists want their health needs addressed, but they also want the ability to plan, clear communication and to feel like someone cares. Instead, they feel forgotten by impersonal and inflexible systems with very little communication, with emergency departments and general practitioners often left to fill in the gaps.ConclusionsMore consumer‐centred approaches are needed for access systems for outpatient and community services, featuring honesty about what services can realistically be provided, early access to initial assessment and information and clear lines of communication.

show abstract

What is the effect of delays in access to specialist epilepsy care on patient outcomes? A systematic review and meta-analysis

Cited by 15 publications

References 61 publications

Timing of referral to evaluate for epilepsy surgery: Expert Consensus Recommendations from the Surgical Therapies Commission of the International League Against Epilepsy

Timing of referral to evaluate for epilepsy surgery: Expert Consensus Recommendations from the Surgical Therapies Commission of the International League Against Epilepsy

Care in Europe after presenting to the emergency department with a seizure; position paper and insights from the European Audit of Seizure Management in Hospitals

‘I just need a plan’: Consumer perceptions of waiting for healthcare

Contact Info

Product

Resources

About