AUDIT OF THE CARE OF PATIENTS WITH EPILEPSY IN GENERAL-PRACTICE

Background. Previous studies have shown that there is great potential for improving the management of patients with epilepsy. Aim. To identi fy all patients with epilepsy, to evaluate and audit their care in rel ation to an annual review, to document seizure frequency and appropria teness of daily therapy to aid compliance and to propose strategies to improve these and other aspects of epileptic care. Method. An audit o f the care of patients with epilepsy was undertaken in two King's Lynn practices with a combined population of 22 500. Principles for the ma nagement of epilepsy were established. From these principles, the foll owing standards were agreed: 75% of patients on treatment for epilepsy should be seen every year, 75% of patients should have their seizure frequency documented, and 75% of patients should take their anti-epile ptic drugs no more than twice daily. As a result of the first audit cy cle, changes were made in the documentation and advice regarding treat ment relating to these standards. Results. The first audit cycle showe d that 83% of patients had been seen at least once in the previous yea r, that documentation of seizure frequency existed for 51% of patients in the past year, and that 63% of patients were taking their treatmen t no more than twice daily. The evaluation was repeated 22 months late r and an overall improvement was demonstrated in the first two results : 95% of patients had been seen in the past year, 93% had had their se izure frequency documented; however, only 66% of patients were faking their treatment twice daily or less. Conclusion. Call and recall, and documentation of seizure frequency were improved by this clinical audi t. However, alterations in daily therapy appeared difficult for a vari ety of reasons; for example, therapy might have been initiated by a ho spital specialist, and patients in a stable condition might have been apprehensive about changes. In order to improve the care of patients w ith epilepsy, a primary care team approach is desirable within a struc ture of good specialist services.