Are epilepsy patients bypassing primary care? A cross-sectional study from India

Kumar, Shrawan; Singh, Mamta Bhushan; Kumar, Amit; Shukla, Geeta; Srivastava, M V Padma; Goyal, Vinay; Vishnu, Venugopalan Y

doi:10.1016/j.seizure.2018.07.001

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…Despite recent government efforts to encourage use of primary care through the removal of user fees, primary care bypassing is extremely common in Lusaka, and Level 1 and Level 3 hospitals are used extensively for non-emergency care. These findings are consistent with a growing literature showing high rates of bypassing in low- and middle-income countries [ 20 – 34 , 36 , 37 , 45 – 48 ]. Our study builds on the existing literature by mapping bypassing patterns in an urban setting.…”

Section: Discussionsupporting

confidence: 93%

Health care seeking in modern urban LMIC settings: evidence from Lusaka, Zambia

et al. 2022

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Background In an effort to improve population health, many low- and middle-income countries (LMICs) have expanded access to public primary care facilities and removed user fees for services in these facilities. However, a growing literature suggests that many patients bypass nearby primary care facilities to seek care at more distant or higher-level facilities. Patients in urban areas, a growing segment of the population in LMICs, generally have more options for where to seek care than patients in rural areas. However, evidence on care-seeking trajectories and bypassing patterns in urban areas remains relatively scarce. Methods We obtained a complete list of public health facilities and interviewed randomly selected informal sector households across 31 urban areas in Lusaka District, Zambia. All households and facilities listed were geocoded, and care-seeking trajectories mapped across the entire urban area. We analyzed three types of bypassing: i) not using health centers or health posts for primary care; ii) seeking care outside of the residential neighborhood; iii) directly seeking care at teaching hospitals. Results A total of 620 households were interviewed, linked to 88 health facilities. Among 571 adults who had recently sought non-emergency care, 65% sought care at a hospital. Among 141 children who recently sought care for diarrhea, cough, fever, or fast breathing, 34% sought care at a hospital. 71% of adults bypassed primary care facilities, 26% bypassed health centers and hospitals close to them for more distant facilities, and 8% directly sought care at a teaching hospital. Bypassing was also observed for 59% of children, who were more likely to seek care outside of the formal care sector, with 21% of children treated at drug shops or pharmacies. Conclusions The results presented here strongly highlight the complexity of urban health systems. Most adult patients in Lusaka do not use public primary health facilities for non-emergency care, and heavily rely on pharmacies and drug shops for treatment of children. Major efforts will likely be needed if the government wants to instate health centers as the principal primary care access point in this setting.

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Section: Discussionsupporting

confidence: 93%

Health care seeking in modern urban LMIC settings: evidence from Lusaka, Zambia

et al. 2022

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“…As discussed in a previous paper, at least 40% of these patients did not actually need tertiary care. [ 15 ] Yet, we found that a significant proportion of patients were already on polytherapy—85% in the non-adherent group and 43% in the adherent group. Excessive, often irrational use of polytherapy reflects a lack of standardization of prescribing practices for epilepsy in the country.…”

Section: Discussionmentioning

confidence: 79%

“…Adherence data were collected during the course of a single center, cross-sectional study conducted at a tertiary care teaching hospital that provides comprehensive epilepsy care in New Delhi, India. [ 15 ] While consecutive epilepsy patients presenting to the Neurology outpatient clinic for the first time had been enrolled in the original study, only those patients who were 18 years or older were included to study adherence. We excluded younger patients as a self-reported scale was being used to assess adherence and reliability in younger patients was uncertain.…”

Section: Ethodsmentioning

confidence: 99%

Medication Adherence in Indian Epilepsy Patients

Kumar¹,

Singh²,

Kumar³

et al. 2021

Annals of Indian Academy of Neurology

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Purpose: While two-thirds of epilepsy patients can become seizure free on medical treatment, poor adherence to medication is a major problem to sustained remission and functional restoration. The aim of this study was to assess the prevalence and associated factors of antiepileptic drug (AED) non-adherence. Methods: We conducted a subgroup analysis based on results that emerged from a single center, cross-sectional study. Patients who were 18 years or older were included. The 4-item Morisky Medication Adherence Scale was used to measure adherence to AED (s). Multivariable logistic regression analysis was used to predict factors associated with AED non-adherence. Results: A total of 268 patients fulfilled inclusion criteria and were included in this subgroup analysis. Among the participants, 81 (30%) were non-adherent to medication. Three factors associated with non-adherence were AED polytherapy [OR: 4.5 (2.1-9.5) P = 0.001], drug related adverse events [OR: 3.9 (2.1-7.3) P = 0.001], and treatment duration exceeding 3 years [OR: 2.6 (1.3-5.0) P = 0.003]. Conclusion: About one-third patients were not compliant with their medication. If the treatment of patients is restricted to monotherapy as far as possible and patients are educated about duration of treatment and possible adverse effects of AEDs, non-adherence may be reduced.

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“…A skewed distribution of specialist doctors with hardly any specialist care available outside of few large metropolitan cities is a serious bottleneck that is difficult to address. We have earlier documented this gap in epilepsy primary and secondary care [12]. A viable option may be to conduct more outreach clinics in the least served communities.…”

Section: Discussionmentioning

confidence: 96%

Comparing long-term outcomes of epilepsy patients from a single-visit outreach clinic with a conventional epilepsy clinic: A cross-sectional observational study from India

Prajapati

Singh

Srivastava

et al. 2019

Seizure

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A B S T R A C TPurpose: To compare long-term treatment outcomes in epilepsy patients from a single-visit outreach clinic on the Lifeline Express (LLE) with a conventional hospital (AIIMS) based epilepsy clinic in India. Methods: Using a cross-sectional observational study design, consecutive epilepsy patients from fifteen LLE clinics conducted from 2009 to 2014 were compared to epilepsy patients registered in the same duration at the AIIMS epilepsy clinic. The primary outcome was to determine if patients were still taking AEDs. To determine current AED status, patients from the LLE clinic were contacted telephonically. For the AIIMS patients, hospital records were reviewed and phone calls made to those patients who had not followed-up for more than a year. Results: In the 5 years under review, 1923 and 1257 patients had consulted at the LLE and AIIMS clinics respectively. Long-term outcomes were available for analysis in 688 AIIMS and 531 LLE clinic patients. Of the AIIMS patients, 581(87%) were continuing AEDs, 49(7%) had discontinued AEDs after being seizure-free for at least 5 years, 39(6%) had discontinued AEDs without medical advice and 19(2.8%) were dead. Outcomes in 531 LLE patients revealed that 351(72%) continued to be on AEDs, 34(7%) had discontinued AEDs on advice, 106 (22%) had discontinued AEDs without any medical advice and 40 (7.5%) were dead. The treatment gap in the LLE patients was reduced from 49% at first contact to 22% at follow-up 2-8 years later. Conclusions: Even single-visit epilepsy clinics may be an effective option for reducing treatment gap in limitedresource regions of the world.

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Are epilepsy patients bypassing primary care? A cross-sectional study from India

Cited by 5 publications

References 15 publications

Health care seeking in modern urban LMIC settings: evidence from Lusaka, Zambia

Health care seeking in modern urban LMIC settings: evidence from Lusaka, Zambia

Medication Adherence in Indian Epilepsy Patients

Comparing long-term outcomes of epilepsy patients from a single-visit outreach clinic with a conventional epilepsy clinic: A cross-sectional observational study from India

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