The association between the quality of epilepsy management in primary care, general practice population deprivation status and epilepsy-related emergency hospitalisations

OBJECTIVE To examine whether there is an association between the quality of epilepsy care, as measured by the Quality and Outcomes Framework of the 2004 General Practitioner contract for England, practice population deprivation status and epilepsy-related emergency hospitalisation. METHODS Linear regression analysis was used to examine the association between the proportion of epilepsy-treated seizure-free patients and the proportion of epilepsy-treated patients with at least one epilepsy-related emergency hospitalisation at the individual practice level, adjusting for practice population deprivation status. The analysis was subsequently repeated by using the rate of epilepsy-related hospitalisations among epilepsy-treated patients (as opposed to the number of patients with at least one hospitalisation), during the same study period. RESULTS After adjusting for practice population deprivation status, there was a significant inverse association between the proportion of epilepsy-treated seizure-free patients and the proportion of epilepsy-treated patients with at least one epilepsy-related emergency hospitalisation. For every 1% increase in the proportion of seizure-free epilepsy-treated patients there was a 0.43% reduction in the number of patients with at least one epilepsy-related emergency hospitalisation (95% Confidence Interval: -0.09 to -0.78, p: 0.014). DISCUSSION The findings indicate a significant and relatively strong relationship between the quality of epilepsy management in primary care (proportion of seizure-free patients) and an important care outcome (epilepsy-related emergency hospitalisation). The findings support the current and future use of Quality Outcomes Framework indicators to measure the quality of epilepsy care.