Department of Neuroscience, Uppsala University Hospital, S-751 85 Uppsala, Sweden.
Neurology. 2010 Jan 26;74(4):295-301. doi: 10.1212/WNL.0b013e3181cbcd5c.
According to the Swedish Health Care Act, patients should be provided with the health care they need, regardless of sociodemographic status. We investigated whether in Sweden sociodemographic differences are associated with access to expert health care and antiepileptic drug (AED) prescriptions in epilepsy.
Patients with epilepsy were identified in the National Patient Register. Persons >or=18 years on continuous AED treatment in 2006 were identified in the recently established Swedish Prescribed Drug Register. Data on sociodemographic variables were obtained from several other national registers. We linked data to examine whether epilepsy patients' access to neurologists and the prescription of individual AEDs are related to sex, age, educational level, area of residence, region of birth, or income. We also assessed whether AEDs are prescribed differently to patients with epilepsy by neurologists as compared to non-neurologists.
We identified 26,124 epilepsy patients in the register who were on continuous AED treatment (effective sample). Being women, young, highly educated, having high incomes, and residing in a larger city meant being more often treated by a neurologist than by other specialists. The prescriptions of AEDs differed according to gender, age, education, place of residence, and income. Lamotrigine and levetiracetam were prescribed to a larger extent by a neurologist rather than by other specialists.
This nationwide cross-sectional study of epilepsy patients indicates that sociodemographic characteristics are important for access to neurologists and prescriptions of individual antiepileptic drugs. Prospective studies using patient-related outcomes are needed to analyze the consequences of these differences.
根据瑞典医疗保健法案，无论社会人口统计学状况如何，患者都应获得所需的医疗保健。我们调查了在瑞典，社会人口统计学差异是否与癫痫患者获得专家医疗保健和抗癫痫药物（AED）处方有关。
在国家患者登记册中确定癫痫患者。在最近建立的瑞典处方药物登记册中，确定了 2006 年持续接受 AED 治疗的年龄≥18 岁的患者。从其他几个国家登记册中获得社会人口统计学变量的数据。我们将数据联系起来，以检查癫痫患者是否可以获得神经科医生的诊治以及是否可以开出特定的 AED，这与性别、年龄、教育程度、居住地区、出生地和收入有关。我们还评估了与非神经科医生相比，神经科医生是否会为癫痫患者开出不同的 AED。
我们在登记册中确定了 26,124 名连续接受 AED 治疗的癫痫患者（有效样本）。女性、年轻、高学历、高收入和居住在较大的城市意味着他们更常由神经科医生而不是其他专家治疗。AED 的处方因性别、年龄、教育程度、居住地和收入而异。与其他专家相比，神经科医生更常开用拉莫三嗪和左乙拉西坦。
这项针对癫痫患者的全国性横断面研究表明，社会人口统计学特征对于获得神经科医生的诊治和开出特定的抗癫痫药物处方很重要。需要使用基于患者相关结果的前瞻性研究来分析这些差异的后果。
