在 COVID-19 大流行期间为耐药性癫痫儿童设立跨学科诊所的概念化和实施。
Conceptualization and implementation of an interdisciplinary clinic for children with drug-resistant epilepsy during the COVID-19 pandemic.
机构信息
Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Division of Neurology, Arkansas Children's Hospital, USA.
出版信息
Epilepsy Behav. 2021 Dec;125:108403. doi: 10.1016/j.yebeh.2021.108403. Epub 2021 Oct 29.
OBJECTIVE
To describe the rapid conceptualization and implementation of an interdisciplinary epilepsy clinic for children with drug-resistant epilepsy (DRE) at Arkansas Children's Hospital (ACH) during the COVID 19 pandemic.
METHODS
Focusing on care design and care coordination for children with DRE, multiple stakeholder groups decided to implement a clinic after the systematic rating of constructs present in a theoretical meta-analytic framework. Based on the projected success, the new interdisciplinary clinic (composed of an epileptologist, a neurosurgeon, and a neuropsychologist and coordinated by a full-time nurse) was established. Clinic operations were further refined through discussions with patients, families, and care providers. We collected data retrospectively (August 2020 to June 2021) to determine referral patterns, clinic scheduling metrics, patient characteristics, clinical recommendations, and epilepsy quality metrics.
RESULTS
Of the 32 Consolidated Framework for Implementation Research constructs assessed, 24 were positively rated to predict a high probability of successful implementation of the clinic. For approximately 100 patient visits, appearance and usage rates were >75%, yielding a clinic utilization rate of approximately 60%. Among 76 unique patients (average age of 12 years, 60% focal epilepsy), 39 patients (51.3%) were deemed eligible for epilepsy surgery evaluation. The majority of the patients (53.9%) were advised for additional diagnostic testing, and 31.6% of patients were scheduled for vagus nerve stimulation. More patients (33%) had changes in their existing anti-seizure medication (ASM) regimen rather than an addition of a new ASM (7.9%). Standardized epilepsy quality measures showed >80% to 90% adherence in 3 (reproductive counseling, depression and anxiety screening, documentation of seizure frequency) out of 4 metrics.
SIGNIFICANCE
This is the first study to show that an interdisciplinary clinic can be a valuable attribute of care models in high-need children with DRE by enabling comprehensive one-stop service for diagnostic evaluation, surgical consideration, and brief assessment of psychiatric comorbidities without compromising consensus-based best practices.
目的
在 COVID-19 大流行期间，描述阿肯色儿童医院（ACH）为耐药性癫痫（DRE）儿童快速概念化和实施跨学科癫痫诊所的过程。
方法
专注于 DRE 儿童的护理设计和护理协调，多个利益相关者团体在对理论元分析框架中的结构进行系统评估后决定实施该诊所。基于预期的成功，建立了新的跨学科诊所（由一名癫痫专家、一名神经外科医生和一名神经心理学家组成，并由一名全职护士协调）。通过与患者、家属和护理提供者的讨论，进一步完善了诊所的运作。我们回顾性收集数据（2020 年 8 月至 2021 年 6 月），以确定转诊模式、诊所预约指标、患者特征、临床建议和癫痫质量指标。
结果
在评估的 32 个实施研究综合框架结构中，有 24 个结构被评为积极，可预测该诊所实施的成功率较高。大约有 100 名患者就诊，就诊率和使用率均超过 75%，诊所利用率约为 60%。在 76 名独特的患者中（平均年龄 12 岁，60%为局灶性癫痫），有 39 名患者（51.3%）被认为有资格接受癫痫手术评估。大多数患者（53.9%）被建议进行额外的诊断性检查，31.6%的患者被安排进行迷走神经刺激。与添加新的抗癫痫药物（ASM）相比，更多的患者（33%）改变了现有的 ASM 方案（7.9%）。4 项指标中有 3 项（生殖咨询、抑郁和焦虑筛查、记录癫痫发作频率）的标准化癫痫质量指标显示出 80%至 90%的依从性。
意义
这是第一项表明，在患有 DRE 的高需求儿童中，跨学科诊所可以成为护理模式的有价值特征的研究，它可以为诊断评估、手术考虑和简要评估精神共病提供一站式综合服务，同时不影响基于共识的最佳实践。
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