The effectiveness of shared care for patients with epilepsy in Nakhon Ratchasima province

Abstract

Objective: To assess the effectiveness of shared care for epilepsy in terms of regularity of follow-up, seizure control, quality of life, patient satisfaction, and reduction of general practitioner's inappropriate practices. Methods: This one-year study was a randomized controlled trial using cluster randomization. All eligible community hospitals were invited to participate in this study. All participating hospitals were stratified into three strata, and each stratum was randomized into control and shared care groups. Epileptics at the participating hospitals were invited to join this study. Results: There were 401 (control group, 179; intervention group, 222) eligible epileptics for this study. All of the baseline characteristics, except number of patients with monotherapy and with concomitant treatments, were not significantly different between the two groups. After stratification and covariate analysis of the different baseline characteristics, patients with monotherapy in shared care had significantly better rates of regular follow-up than the control (p-value < 0.05). However, in srizure reduction, quality of life, and patient-satisfaction, there was no difference between the control and shared care groups. Patients and general practitioners rated shared care interventions highly useful. Patients applied most of the knowledge to self-care. General practiioners greatly improved their knowledge of epilepsy treatments. Conclusion: shared care is effective in terms of regularity of follow-up for epileptics with non-serious conditions and very useful for patients and primary health care teams. It is expected that it would be beneficial for seizure reduction, quality of life, and patient-satisfaction, if the study period were prolonged to two to five years.