Bailey Jason, West Melanie, Agarwal Rajkumar, Kumar Gogi
Division of Child Neurology, Dayton Children's Hospital, Dayton, OH, USA.
Division of Psychiatry, Dayton Children's Hospital, Dayton, OH, USA.
Child Neurol Open. 2021 Apr 27;8:2329048X211012544. doi: 10.1177/2329048X211012544. eCollection 2021 Jan-Dec.
Epilepsy is one of the most common neurological disorders in children. Missed appointments reflect 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 missed appointments in children with epilepsy and measure the relation between missed appointments and frequency of emergency room (ER) visits and inpatient admissions.
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 2 or more missed neurology clinic appointments in the previous year ("study group", n = 36) were compared to those with 1 or zero 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 SPSS and p < 0.05 was considered significant.
The mean age, gender distribution and presence of medical refractoriness were comparable between the 2 groups. Families in the study group reported a higher likelihood of having to make special work arrangements for clinic appointments. Children in the study group were noted to have a significantly higher frequency of single mother households, presence of public insurance, father not graduating from high school and household income less than 50,000 dollars. Within the preceding year, children in the study group were noted to have a higher frequency of visits to the emergency department as well as 6 times higher likelihood of inpatient hospitalization for seizures.
Social determinants of health play an important role in determining adherence with neurology clinic visits in children with epilepsy. Children with more missed appointments are likely to have a higher frequency of visits to the emergency department as well as a higher incidence of hospitalization for seizures. Identification of high-risk families and implementation of early interventions may improve adherence to office visits and decrease emergency room visits and hospitalization for seizures.
癫痫是儿童最常见的神经系统疾病之一。预约失约意味着错失了为癫痫患儿提供护理的机会。本研究的目的是确定健康的社会决定因素（SDH）以及与癫痫患儿预约失约相关的其他因素，并衡量预约失约与急诊室（ER）就诊频率和住院情况之间的关系。
这是一项在四级癫痫中心的神经科进行的前瞻性研究。纳入诊断为癫痫的儿童（0至<18岁），并向其家庭提供一份半结构化问卷。将前一年有2次或更多次神经科门诊预约失约的患者（“研究组”，n = 36）与预约失约1次或0次的患者（“对照组”，n = 49）进行比较。对过去一年的临床特征、急诊室就诊和住院情况以及健康的社会决定因素进行了比较。使用SPSS进行统计分析，p < 0.05被认为具有统计学意义。
两组之间的平均年龄、性别分布和药物难治性情况相当。研究组的家庭报告称，为门诊预约做出特殊工作安排的可能性更高。研究组的儿童单亲家庭比例、拥有公共保险的比例、父亲未高中毕业的比例以及家庭收入低于50,000美元的比例显著更高。在前一年中，研究组的儿童急诊就诊频率更高，因癫痫住院的可能性是对照组的6倍。
健康的社会决定因素在决定癫痫患儿对神经科门诊的依从性方面起着重要作用。预约失约较多的儿童急诊就诊频率可能更高，癫痫住院发生率也更高。识别高危家庭并实施早期干预可能会提高门诊就诊的依从性，并减少急诊就诊和癫痫住院情况。
