Review of Patients in General Practice with a Diagnosis of Epilepsy: Development of a Practice Nurse Checklist and an Assessment of Resource Implications

Abstract

Background: SIGN has recommended annual review of all patients with epilepsy. Annual review is rewarded in the new GMS contract. There is no information on how or by whom reviews should be carried out, nor on resource implications for secondary care. Aims: To determine whether a practice nurse can deliver annual review of patients with epilepsy, and to estimate the resource implications of such review. Methods: Evaluation of a practice nurse checklist against review by neurologist in 62 patients with epilepsy identified from a practice list of 6240 from Southwest Glasgow LHCC, and audit of case records in 1259 patients with epilepsy identified from the whole LHCC population of 96,565. Results: There were 8 discrepancies between nurse and doctor reviews in a first iteration, but none in the second. Changes suggested a training effect. The review process generated 19 epilepsy nurse appointments, 7 requests for cerebral imaging and 3 requests for video EEG. Twelve patients required continuing follow up. The LHCC audit identified a large number of patients who had inadequate documentation of information and advice (over 90% in some domains). 28.6% had not been seen by a specialist, 40.7% had not had cerebral imaging, and only 37.4% were seizure free. Conclusion: Annual reviews of patients with epilepsy can be carried out by practice nurses, but some training is required. The review process is likely to increase the burden on secondary care and have a significant adverse effect on neurology waiting times.