15-7-2009 | New Irish research published on epilepsy care in General Practice

15 July 2009
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A study published in the current issue of the Irish Medical Journal explores the role of the Irish GP in managing the healthcare of people with epilepsy.

The study consists of a questionnaire completed by 247 GPs from all over Ireland and was conducted by the Epilepsy Programme at Beaumont Hospital, the Irish College of General Practitioners and the Department of Health Policy & Management, Trinity College.

The researchers found that GPs face significant barriers in managing people with epilepsy in primary care. They found that GPs were very dissatisfied with existing neurology services, including pathways of referral (84%) and access to specialist neurology advice and investigations (94%). Only 6% of GPs said they could always access an urgent MRI scan within 12 weeks while 36% said they could never do so.

In addition, GPs reported that neurology services and investigations may be easier to access if patients have private health insurance (72%).

International guidelines state that a person with suspected epilepsy should be reviewed and diagnosed by a neurologist within two weeks. However, poor access to neurology services mean that people with epilepsy are often referred by their GP to A&E for assessment and treatment (73%), a course of action which is often inappropriate and costly.

The GP is generally the primary care giver for people with epilepsy. However, according to the study, the majority of GPs perceive their role primarily as educationalists, providing information regarding lifestyle issues and monitoring responses to AED therapy. While GPs overwhelmingly agreed with the concept of epilepsy shared care (96%), a deficit in epilepsy care expertise among GPs was acknowledged by 35%.

Poor communication between various healthcare providers was also reported as a significant barrier to providing care to people with epilepsy. Beaumont hospital are currently developing and deploying an epilepsy-specific Electronic Patient Record (EPR) to consolidate the medical records of people with epilepsy attending the hospital. While access is currently restricted to authorised staff within the hospital, it is proposed to make the EPR available to authorised external users in the future such as GPs. The study found that 93% of GPs supported the concept the EPR. 

Similar to previous findings, the study found that Irish GPs are less likely to initiate or manage the more complex aspects of epilepsy care such as initiating AED therapy or managing PWE during pregnancy.

The role of the epilepsy clinical nurse specialist as a means of improving the quality of epilepsy care was well supported by GPs (83%). Brainwave believes that more epilepsy specialist nurses are urgently required.

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