Effect of a primary-care-based epilepsy specialist nurse service on quality of care from the patients' perspective: quasi-experimental evaluation

Initiatives to improve epilepsy care have emphasized the role of specialist nurses. Formal evaluation of these initiatives are scarce. Further evaluat ive studies are required to ascertain the optimal means of providing epilep sy care. This study aimed to assess the effect of a primary-care-based epil epsy specialist nurse service on patients' reported health status, perceive d quality of life, health care use, attitudes to health care, and provision of information. A quasi-experimental follow-up questionnaire survey was se nt to all 574 patients aged 16 years or over and receiving antiepileptic dr ugs for epilepsy, registered in 14 general practices in north-west Bristol. Patients in seven practices who received the new service (intervention pat ients) were compared with patients in seven practices who did not (control patients). Follow-up comparisons between intervention and control patients were adjusted for baseline differences. Response rates to the first, second and both surveys were 66.2%, 68.6% and 50.9%, respectively. Intervention p atients were more likely than control patients to have discussed most epile psy topics with general practitioners and/or hospital doctors, and were sig nificantly more likely to have categorized general practitioner care as exc ellent (odds ratio (OR) 2.30, 95% confidence intervals (CI) 1.12-4.70). Int ervention patients were significantly less likely than controls to have rep orted never missing taking their anti-epileptic drugs (OR 0.48, 95% CI 0.24 -0.94). There were no significant changes in measures of health status, use of other health care services, and perceived quality of life between inter vention and control patients. This study provides evidence of an improvemen t, after 1 year, in communication and satisfaction but not health status re sulting from the introduction of a primary-care-based epilepsy service.