Krauss Gregory, Sandy Sherry, Corbin David O C, Bird-Compton Jacqueline, Jack Frances, Nelson Beverly, Jalonen Tuula O, Ali Amza, Fortuné Taryn, Clarke Dave, Okolie Jacqueline, Cervenka Mackenzie C
Department of Neurology, Johns Hopkins University, Meyer 2-147, 600 N Wolfe St., Baltimore, MD 21287, USA.
Medicine Department, University of the West Indies, Champ Fleurs, St. Augustine, Trinidad and Tobago.
Epilepsy Behav. 2015 Oct;51:267-72. doi: 10.1016/j.yebeh.2015.07.011. Epub 2015 Aug 24.
Very little has been reported about the health resources available for patients with epilepsy in the five English-speaking southern Caribbean countries of Trinidad and Tobago, Barbados, Grenada, Saint Vincent and the Grenadines, and Saint Lucia. There is no comprehensive resource describing their health systems, access to specialty care, antiepileptic drug (AED) use, and availability of brain imaging and EEG. The purpose of this study was to profile epilepsy care in these countries as an initial step toward improving the standard of care and identifying gaps in care to guide future policy changes. In each southern Caribbean country, we conducted study visits and interviewed health-care providers, government health ministers, pharmacy directors, hospital medical directors, pharmacists, clinic staff, radiologists, and radiology and EEG technicians. Health-care providers completed extensive epilepsy care surveys. The five countries all have integrated government health systems with clinics and hospitals that provide free or heavily subsidized care and AEDs for patients with epilepsy. Only Trinidad and Tobago and Barbados, however, have neurology specialists. The three smaller countries lack government imaging and EEG facilities. Trinidad had up to one-year waits for public MRI/EEG. Government formularies in Grenada, Saint Vincent and the Grenadines, and Saint Lucia are limited to first-generation AEDs. One or more second-line agents are formulary in Trinidad and Barbados. Nonformulary drugs may be obtained for individual patients in Barbados. Grenada, Saint Lucia, and Saint Vincent and the Grenadines participate in an Organization of Eastern Caribbean States formulary purchasing system, which added levetiracetam following the survey. Newer generic AED formulations with the lowest risks for pregnancy malformation were not in use. In conclusion, patients with epilepsy in the southern Caribbean have excellent access to government clinics and hospitals, but AED choices are limited. Local medical providers reported that the major limitations in care were lack of specialty care, lack of imaging and EEG services, financial barriers to care, long wait times for care, and limited access to additional AEDs.
关于特立尼达和多巴哥、巴巴多斯、格林纳达、圣文森特和格林纳丁斯以及圣卢西亚这五个加勒比海地区讲英语的南部国家中癫痫患者可获得的医疗资源，相关报道极少。目前尚无全面的资料描述这些国家的医疗体系、专科护理的可及性、抗癫痫药物（AED）的使用情况以及脑部成像和脑电图检查的可获得性。本研究的目的是剖析这些国家的癫痫护理情况，作为提高护理标准以及识别护理差距以指导未来政策变革的第一步。在每个加勒比海地区南部国家，我们进行了实地考察，并采访了医疗服务提供者、政府卫生部长、药房主任、医院医务主任、药剂师、诊所工作人员、放射科医生以及放射学和脑电图技术人员。医疗服务提供者完成了详尽的癫痫护理调查。这五个国家均拥有整合的政府医疗体系，设有诊所和医院，为癫痫患者提供免费或高额补贴的护理及抗癫痫药物。然而，只有特立尼达和多巴哥以及巴巴多斯有神经科专科医生。三个较小的国家缺乏政府的成像和脑电图检查设施。在特立尼达，等待公共磁共振成像/脑电图检查长达一年。格林纳达、圣文森特和格林纳丁斯以及圣卢西亚的政府药品目录仅限于第一代抗癫痫药物。在特立尼达和巴巴多斯，一种或多种二线药物被列入药品目录。在巴巴多斯，个别患者可获取非目录药物。格林纳达、圣卢西亚以及圣文森特和格林纳丁斯参与了东加勒比国家组织的药品目录采购系统，该系统在调查后新增了左乙拉西坦。风险最低的新型通用抗癫痫药物制剂尚未投入使用。总之，加勒比海地区南部的癫痫患者能够很好地利用政府诊所和医院，但抗癫痫药物的选择有限。当地医疗服务提供者报告称，护理方面的主要限制包括缺乏专科护理、缺乏成像和脑电图服务、护理的经济障碍、护理等待时间长以及获取其他抗癫痫药物的机会有限。
