Doctoral Candidate Case Western Reserve University
Rationale: People with epilepsy face barriers to timely and adequate care, despite evidence that patients with poorly controlled seizures benefit substantially from seeing a neurologist or an epileptologist. Data on patterns of diagnostic evaluation of seizures, being on antiepileptic drugs (AED), AED adherence, and follow-up care remains limited. Few studies have evaluated the occurrence of negative health events (NHEs) such as emergency department (ED) visits and hospitalizations, which may be associated with poor epilepsy control. Failure to access timely and appropriate care can result in these NHEs, while PWE who are seen by a neurologist may be more likely to undergo diagnostic testing and receive appropriate follow-up. Methods: Using Medicaid claims (2010 – 2014) from 15 geographically diverse states, we identified adults with incident epilepsy in 2012 and 2013, 18 through 62 years of age at time of epilepsy diagnosis, and enrolled in Medicaid for the entire study period (n=19,911). Using successive logistic regression models, we evaluated five outcomes that might indicate potential disparities in care patterns: seeing a neurologist, receiving diagnostic care, adhering to an AED, having serum levels checked, and being in the top quartile of NHEs. Each successive model was adjusted for demographic characteristics, comorbidities, and structural factors at the county level (e.g., neurologist density), and the outcome from the preceding models. Results: Of incident epilepsy cases, 44.9% saw a neurologist following diagnosis. Older adults, racial minorities, and persons living where there were fewer neurologists were less likely to see a neurologist. Sixty-seven percent of PWE received at least one diagnostic test; 60% of PWE adhered to their medications; and 52% had serum drug levels checked. Hypertension was the most common comorbidity, with a prevalence of 37.1%, followed by other psychoses (27%). Individuals with most comorbidities, except diabetes, drug abuse, and psychoses, were more likely to see a neurologist. After controlling for treatment factors, demographic characteristics, and residential-level factors, those with comorbidities were more likely to be in the top quartile of NHEs including an adjusted odds ratio of 2.92 (95% CI: 2.64, 3.24) for PWE with drug abuse and 2.01 (95% CI: 1.83, 2.20) for PWE with depression. Those with substance use disorders, were less adherent with AEDs and had more NHEs. Conclusions: Less than half of adults on Medicaid with newly diagnosed epilepsy were seen by a neurologist after their index epilepsy date. Racial minorities, rural residents, those with psychoses, and those living in areas with low neurologist density were less likely to have seen a neurologist. When controlling for seeing a neurologist and receiving care, there remain racial and ethnic disparities in outcomes. Developing access and care approaches to reduce health disparities among racial and ethnic minorities with epilepsy, and those with complex comorbidities, remains a continued and critical need. Funding: Please list any funding that was received in support of this abstract.: This work was funded by the CDC SIP 3 U48 DP005030-05S1, and the findings and conclusions in this abstract do not represent the official position of the CDC.