Thomas S V, Mohan P K, Alexander A, Menon P K
Department of Neurology, Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
Natl Med J India. 1995 Jul-Aug;8(4):165-8.
Epilepsy services in India are mostly located in urban areas and are often overcrowded. It is difficult, therefore, to organize long term management programmes. We report our experience at a tertiary referral centre on follow up of patients with epilepsy through regular postal review.
One hundred consecutive patients with epilepsy (63 men, 37 women, mean age 17 years) who had only seizures were followed up by post using a questionnaire, instead of reviewing them in a clinic. The safety, utility and efficiency of this system were evaluated.
Sixty patients had generalized seizures, 30 had complex partial seizures and 10 had other types of seizures. The indication for shifting to postal review was good control of seizures in 87 cases and economic reasons in the remaining. Postal review constituted 60% of the total follow up period in 55 cases. Sixty-six patients could be maintained on postal review which was suspended or discontinued in 34 patients. Of these 34, 16 were returned to it after being seen in the clinic on a further occasion. Poor control of seizures, fresh medical or social problems, lack of confidence or a combination of these were the reasons for discontinuing the postal review. The economic benefit to a patient by way of savings in travel, incidental expenses and lost wages was estimated to be Rs 750 per annum. The work load in the epilepsy clinic was decreased by 40%. No serious medical problems or mortality were reported in the study population.
Systematic postal review is a cost-effective alternative to clinic review in the long term follow up of a certain group of patients with epilepsy.
印度的癫痫服务大多位于城市地区，且常常人满为患。因此，组织长期管理项目很困难。我们报告了在一家三级转诊中心通过定期邮政随访对癫痫患者进行跟踪的经验。
连续100例仅有癫痫发作的患者（63名男性，37名女性，平均年龄17岁）通过邮寄问卷进行随访，而非在诊所进行复查。对该系统的安全性、实用性和效率进行了评估。
60例患者为全身性发作，30例为复杂部分性发作，10例为其他类型发作。转为邮政随访的原因，87例是癫痫发作得到良好控制，其余是经济原因。55例中邮政随访占总随访期的60%。66例患者可通过邮政随访维持病情，34例患者的邮政随访被暂停或终止。在这34例中，16例在再次到诊所就诊后又恢复了邮政随访。癫痫发作控制不佳、出现新的医疗或社会问题、缺乏信心或这些因素的综合作用是终止邮政随访的原因。据估计，患者每年通过节省差旅费、杂费和工资损失获得的经济收益为750卢比。癫痫诊所的工作量减少了40%。研究人群中未报告严重医疗问题或死亡情况。
在对某组癫痫患者的长期随访中，系统的邮政随访是一种比诊所复查更具成本效益的替代方式。
