Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Seizure. 2017 Dec;53:55-61. doi: 10.1016/j.seizure.2017.11.003. Epub 2017 Nov 7.
Our objective was to assess how telephonic review of outpatients with stable epilepsy compared with conventional face-to-face clinic management.
We constructed a randomized parallel group study of suitable patients attending our Epilepsy Clinic and compared telephonic review with conventional clinic visit based management. Primary outcomes were the percentage of patients with breakthrough seizures and total number of breakthrough seizures. We also compared cost, patient satisfaction and numbers defaulting.
A total of 465 patients were randomized and 429 were included in the final analysis. There was no significant difference in breakthrough seizures between the two groups. Mean time spent in the consultation was 10min in the telephone group (FT) and 22h in the face-to-face group (FC) and cost was INR 865 more expensive on an average in the FC group. Satisfaction was over 90% in the FT group. Significantly more people in the FC group were lost to follow-up.
This study provides Class I evidence that the number of stable epilepsy patients who have breakthrough seizures and the total number of breakthrough seizures remain the same irrespective of whether patients are reviewed telephonically or face-to-face in the clinic. Clinicians managing epilepsy patients should consider using telephonic review for selected patients. Telephonic reviews have the potential of effectively reducing the secondary treatment gap in millions of patients who do not have easy access to doctors.
我们旨在评估稳定型癫痫患者的电话随访与传统面对面门诊管理相比的效果。
我们构建了一项适合在我们癫痫诊所就诊的患者的随机平行组研究，并比较了电话随访与传统门诊就诊的管理方式。主要结局指标是突破性癫痫发作的患者比例和突破性癫痫发作的总次数。我们还比较了成本、患者满意度和失访人数。
共有 465 名患者被随机分组，429 名患者纳入最终分析。两组之间突破性癫痫发作的发生率无显著差异。电话组（FT）的平均咨询时间为 10 分钟，面对面组（FC）为 22 小时，FC 组的平均成本高出 INR 865。FT 组的满意度超过 90%。FC 组中有更多的人失访。
本研究提供了 I 级证据，即无论患者在诊所是通过电话还是面对面接受随访，稳定型癫痫患者中发生突破性癫痫发作的患者比例和突破性癫痫发作的总次数保持不变。管理癫痫患者的临床医生应考虑为选定的患者使用电话随访。电话随访有可能有效地减少那些无法轻易获得医生治疗的数百万患者的二级治疗差距。
