Eastern Health Clinical School, Monash University, Box Hill, VIC, 3128; Department of Neurosciences, Eastern Health, 5 Arnold St, Box Hill, VIC 3128, Australia; The Florey Institute for Neuroscience and Mental Health, Melbourne Brain Centre, Burgundy Street, Heidelberg, VIC 3084, Australia.
Monash Health, Clayton, VIC 3168, Australia.
Epilepsy Behav. 2024 Oct;159:110022. doi: 10.1016/j.yebeh.2024.110022. Epub 2024 Aug 30.
Timely access to specialist outpatient clinics can be difficult to achieve as outpatient services are often oversubscribed leading to unacceptable wait times. New patients, or those with emergent issues may wait for appointments whilst existing patients are booked in for routine reviews "just in case" there is a problem, using considerable clinic resources. We investigated routine 12-month review appointments to assess whether these appointments changed patient management.
The medical records of 100 randomly selected adult patients attending annual review appointments over 12 months at a publicly-funded specialist outpatient epilepsy clinic in Melbourne, Australia were audited. Demographic and clinical data as well as information about the content of each appointment were analysed to determine whether the appointment resulted in changes to epilepsy management (eg medication change), administrative actions (eg drivers license approval) or the provision of information or education. Logistic regression was performed to assess what clinical factors were associated with changes in patient care arising from the 12-month review appointment.
Almost half (47%) of appointments resulted in no change to patient care and 37% had only administrative outcomes, such as the completion of a regulatory driving report. Only 16% of appointments resulted in a change in medical management. The only factor that independently predicted a change in medical management was the occurrence of a seizure in the previous year. The only factor independently associated with not having any change in medical management or administrative action was having an unknown seizure type.
CONCLUSIONS/ SIGNIFICANCE: Only a small number of patients experience a change in medical management when attending a 12-month epilepsy clinic appointment, with a need for management change associated with the presence of ongoing seizure. Outpatient services should limit the use of routine annual follow up to those patients most likely to need intervention or support, creating "just in time" capacity for timely access to review as issues arise.
由于门诊服务经常超额预订，导致等待时间不可接受，因此，专科门诊的及时就诊可能难以实现。新患者或有紧急问题的患者可能会在预约时等待，而现有患者则会为常规复查预约“以防万一”，这会耗费大量的门诊资源。我们调查了常规的 12 个月复查预约，以评估这些预约是否改变了患者的管理方式。
在澳大利亚墨尔本一家由公共资金资助的专科门诊癫痫诊所，对 100 名随机选择的成年患者在 12 个月内接受年度复查预约的医疗记录进行了审核。分析了人口统计学和临床数据，以及每次预约的内容信息，以确定预约是否导致癫痫管理（例如药物治疗的改变）、行政措施（例如驾驶执照的批准）或提供信息或教育发生变化。采用逻辑回归分析评估哪些临床因素与 12 个月复查预约导致的患者护理变化相关。
近一半（47%）的预约没有改变患者的护理，37%的预约仅产生行政结果，例如完成法规驾驶报告。只有 16%的预约导致医疗管理的改变。唯一独立预测医疗管理改变的因素是过去一年中是否发生过癫痫发作。唯一与医疗管理或行政措施无变化独立相关的因素是癫痫发作类型未知。
结论/意义：只有一小部分患者在参加 12 个月的癫痫诊所预约时经历了医疗管理的改变，需要进行管理改变与持续存在的癫痫发作有关。门诊服务应将常规年度随访限制在最需要干预或支持的患者，以在出现问题时及时提供“即时”的审查机会。
