(196) Barriers to adherence to neurology clinic appointments for children with epilepsy – A pilot study

This abstract has been invited to present during the Better Patient Outcomes through Diversity Platform poster session

Rationale: Lack of adherence to neurology clinic appointments reflects missed opportunity to provide care for children with epilepsy. The objective of this study was to identify social determinants of health (SDH) and other factors associated with non-adherence to office visits in children with epilepsy

Methods: This was a prospective study conducted in the neurology division at a Level 4 epilepsy center. Children (0 to < 18 years of age) with a diagnosis of epilepsy were included and a semi-structured questionnaire was provided to the families. Patients with two or more missed neurology clinic appointments in the previous year (“study group”, n=36) were compared to those with one or less missed appointments (“control group”, n=49). A comparison of the clinical characteristics, emergency room visits and hospitalizations in the past year as well as SDH was performed. Statistical analysis was performed using IBM SPSS v26.0 for Windows and p< 0.05 was considered significant.

Results: The mean age, gender distribution and presence of medical refractoriness were comparable between the two groups. There was no difference in the perceived difficulty in keeping neurology appointments (16/36 vs. 26/49, p=0.867) or scheduled frequency of neurology visits (frequency matched patient’s needs: 31/36 vs. 45/49, p=0.643) between the study and control groups. There was no significant difference reported in the need for special arrangements for transportation (9/36 vs. 6/49, p=0.127), lodging (2/36 vs. 0/49, p=0.176) and childcare (5/36 vs. 11/49, p=0.318). Families in the study group reported a higher likelihood of having to make special work arrangements for clinic appointments (28/36 vs. 28/49, p=0.0045). Children in the study group were noted to have a higher frequency of single mother households (24/36 vs. 17/49, p=0.002), presence of public insurance (30/36 vs. 21/49, p< 0.001), father not graduating from high school (12/29 vs. 3/42, p=0.001) and household income less than 10,000 dollars (8/31 vs. 3/42, p=0.005). Within the preceding year, children in the study group were also noted to have a higher frequency of visits to the emergency department (3.1 visits vs .1.6 visits, p=0042) as well as six times higher likelihood of inpatient hospitalization for seizures.

Conclusions: Social determinants of health play an important role in determining adherence to neurology clinic visits in children with epilepsy. Some of these factors include single-mother households, presence of public insurance, lack of high-school graduation of father as well as household income less than 10,000 dollars. Children with more than two missed neurology visits were noted to have a higher frequency of visits to the emergency department as well as a higher incidence of hospitalization for seizures within the past year. Identification of high-risk families and implementation of appropriate and early interventions may not only improve adherence to office visits but also potentially decrease emergency room visits and hospitalization for breakthrough seizures.

Funding: Please list any funding that was received in support of this abstract.: None