Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 4770 Buford Highway NE, MS 107-6, Atlanta, GA 30341, USA.
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 4770 Buford Highway NE, MS 107-6, Atlanta, GA 30341, USA.
Epilepsy Behav. 2021 Dec;125:108385. doi: 10.1016/j.yebeh.2021.108385. Epub 2021 Nov 2.
Monitoring primary care providers' (PCP) attitudes and experiences with referrals of their patients with new-onset seizures or existing epilepsy/seizure disorders may help evaluate whether interventions to coordinate PCP and neurology care reduce treatment gaps and improve patient outcomes. To examine PCPs' attitudes toward, and experiences with, referral to specialty care of their patients with new-onset seizures or existing epilepsy/seizure disorders, we used cross-sectional 2018 DocStyles data to examine study outcomes. We selected a subsample of respondents who had a practice with at least 1% of patients with an epilepsy/seizure disorder and who answered questions about this disorder. We stratified provider actions, referral behavior, and referral enabling factors and barriers by epilepsy/seizure disorder caseload and provider type. We examined different patterns of responses by referral behavior and provider type. The final sample (n = 1284) included 422 family practitioners, 432 internists, 233 pediatricians, and 197 nurse practitioners. Most PCPs refer their patients with new-onset seizures to a neurologist, particularly to determine or confirm the diagnosis and appropriate treatment. Strikingly, about 40% of PCPs did not indicate a referral if their epilepsy/seizure disorder patient was unresponsive to treatment. Internists less likely referred their patients than pediatricians, nurse practitioners, or family practitioners. Less than one-third of all practitioners consulted seizure treatment guidelines. Prompt appointments, communication with the PCP, the patient's insurance, and referral back to primary care may facilitate referrals. Interventions that enhance enabling factors for guidelines-based care and that can increase opportunities for PCPs to consult with neurologists and/or refer their patients with uncontrolled seizures to specialty care are warranted.
监测初级保健提供者（PCP）对其新发癫痫或现有癫痫/癫痫障碍患者转诊的态度和经验，可能有助于评估是否通过干预措施协调 PCP 和神经病学护理，从而减少治疗差距并改善患者预后。为了研究 PCP 对新发癫痫或现有癫痫/癫痫障碍患者转诊到专科护理的态度和经验，我们使用 2018 年 DocStyles 的横断面数据来检查研究结果。我们选择了一个亚样本，该亚样本中至少有 1%的患者患有癫痫/癫痫障碍，并且回答了有关该疾病的问题。我们按癫痫/癫痫障碍患者人数和提供者类型对提供者的行为、转诊行为以及转诊的促进因素和障碍进行分层。我们通过转诊行为和提供者类型来检查不同的反应模式。最终样本（n=1284）包括 422 名家庭医生、432 名内科医生、233 名儿科医生和 197 名护士从业者。大多数 PCP 会将新发癫痫患者转介给神经科医生，特别是为了确定或确认诊断和适当的治疗。引人注目的是，大约 40%的 PCP 表示如果他们的癫痫/癫痫障碍患者对治疗无反应，则不会转介。与儿科医生、护士从业者或家庭医生相比，内科医生不太可能转介他们的患者。不到三分之一的医生会咨询癫痫治疗指南。及时预约、与 PCP 的沟通、患者的保险以及转回初级保健可能会促进转诊。需要采取干预措施，以增强基于指南的护理的促进因素，并增加 PCP 与神经病学家咨询和/或将未得到控制的癫痫患者转介给专科护理的机会。
