Markers of Quality Care for Newly Diagnosed People With Epilepsy on Medicaid

Bibliographic Data

ID9098464
AuthorsWyatt P Bensken (0000-0002-2597-9732, Case Western Reserve University, corresponding author), Suparna M Navale (Case Western Reserve University), Suparna Navale (0000-0003-0782-8591, Case Western Reserve University, corresponding author), Angeline S Andrew (0000-0002-3731-5300, Department of Neurology, Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH), Barbara C Jobst (0000-0001-9243-2238, Department of Neurology, Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH), Martha Sajatovic (0000-0002-3073-668X, Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH), Siran M Koroukian (0000-0002-8106-9581, Case Western Reserve University, corresponding author)
Year2021
Volume59
Issue7
Pages588-596
Publication date2021-07-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001541
PMID33797505
OpenAlexW3139713277
LanguageEN
References cited30

BACKGROUND: For newly diagnosed people with epilepsy (PWE), proper treatment is important to improve outcomes, yet limited data exist on markers of quality care. OBJECTIVE: Examine markers of quality care for newly diagnosed PWE. METHODS: Using Medicaid claims data (2010-2014) for 15 states we identified adults 18-64 years of age diagnosed with incident epilepsy in 2012 or 2013. We built 5 sequential logistic regression models to evaluate: (1) seeing a neurologist; (2) diagnostic evaluation; (3) antiepileptic medication adherence; (4) serum drug levels checked; and (5) being in the top quartile of number of negative health events (NHEs). We adjusted for demographics, comorbidities, county-level factors, and the outcomes from all prior models. RESULTS: Of 25,663 PWE, 37.3% saw a neurologist, with decreased odds for those of older age, those residing in counties with low-density of neurologists, and certain race/ethnicities; about 57% of PWE received at least 1 diagnostic test; and nearly 62% of PWE were adherent to their medication. The most common comorbidities were hypertension (37.1%) and psychoses (26.9%). PWE with comorbidities had higher odds of seeing a neurologist and to have NHEs. Substance use disorders were negatively associated with medication adherence and positively associated with high NHEs. CONCLUSIONS: There are notable differences in demographics among people with incident epilepsy who do or do not see a neurologist. Differences in NHEs persist, even after controlling for neurologist care and diagnostic evaluation. Continued attention to these disparities and comorbidities is needed in the evaluation of newly diagnosed PWE

Comorbidity · Confidence interval · Demographics · Epilepsy · Ethnic group · Family medicine · Health care · Logistic regression · Medicaid · MEDLINE · Odds · Odds ratio · Psychiatry · Quartile · Demography · Epilepsy research and treatment · Internal Medicine · Medication Adherence and Compliance · Medicine · Pharmacological Effects and Toxicity Studies · Pediatrics

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