Preethy Paul1, Meena Agarwal1, Rohit Bhatia2, Sreenivas Vishnubhatla3, Mamta Bhushan Singh4. 1. College of Nursing, All India Institute of Medical Sciences, New Delhi, India. 2. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. 3. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India. 4. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: mbsneuro@gmail.com.
Abstract
PURPOSE: India has an epilepsy treatment gap of up to 90%. Shortage of doctors, especially in rural communities makes getting epilepsy treatment almost impossible for the vast majority. Nurses are relatively more in number and available even in smaller cities and villages. This pilot study investigated if a nurse-led epilepsy follow-up clinic is feasible in India and is acceptable to patients. METHOD: A II year Nursing postgraduate student was given 8h of didactic teaching tailored for epilepsy patient follow-up, followed by supervised observation time in the epilepsy clinic with a neurologist before conducting epilepsy follow-up clinics independently. Epilepsy patients ≥ 10 years of age and in follow-up for ≥ 6 months were included. They were independently followed-up both in the nurse-led clinic and in the neurologist's clinic. Outcome was measured in terms of interrater agreement (kappa) between the recommendations of the neurologist and the nurse in five domains. Patient satisfaction for nurse-led clinic was also evaluated. RESULTS: The interrater agreement between the trained nurse and neurologist in following-up 175 enrolled patients was 76-94%; most unanimity (κ=94%) seen in identifying AED adverse effects while least agreement (κ=76%) was present regarding decisions to modify AED. The mean patient satisfaction score was 37.63 ± 3.26 (maximum possible score 40). CONCLUSION: It is feasible for trained nurses to run epilepsy follow-up clinics in India and patients are likely to be satisfied with this approach.
PURPOSE: India has an epilepsy treatment gap of up to 90%. Shortage of doctors, especially in rural communities makes getting epilepsy treatment almost impossible for the vast majority. Nurses are relatively more in number and available even in smaller cities and villages. This pilot study investigated if a nurse-led epilepsy follow-up clinic is feasible in India and is acceptable to patients. METHOD: A II year Nursing postgraduate student was given 8h of didactic teaching tailored for epilepsypatient follow-up, followed by supervised observation time in the epilepsy clinic with a neurologist before conducting epilepsy follow-up clinics independently. Epilepsypatients ≥ 10 years of age and in follow-up for ≥ 6 months were included. They were independently followed-up both in the nurse-led clinic and in the neurologist's clinic. Outcome was measured in terms of interrater agreement (kappa) between the recommendations of the neurologist and the nurse in five domains. Patient satisfaction for nurse-led clinic was also evaluated. RESULTS: The interrater agreement between the trained nurse and neurologist in following-up 175 enrolled patients was 76-94%; most unanimity (κ=94%) seen in identifying AED adverse effects while least agreement (κ=76%) was present regarding decisions to modify AED. The mean patient satisfaction score was 37.63 ± 3.26 (maximum possible score 40). CONCLUSION: It is feasible for trained nurses to run epilepsy follow-up clinics in India and patients are likely to be satisfied with this approach.