Sociodemographic disparities in epilepsy care: Results from the Houston/New York City health care use and outcomes study

The University of Texas, School of Public Health, Division of Management, Policy, and Community Health, Houston, Texas, USA.
Epilepsia (Impact Factor: 4.57). 12/2008; 50(5):1040-50. DOI: 10.1111/j.1528-1167.2008.01898.x
Source: PubMed


The purpose of this study was to identify sociodemographic disparities in health care use among epilepsy patients receiving care at different sites and the extent to which the disparities persisted after adjusting for patient characteristics and site of care.
Three months of health care use data were obtained from baseline interviews of approximately 560 patients at four sites. One-half of the patients were from a Houston site and two NYC sites that serve predominantly low-income, minority, publicly insured, or uninsured patients. The other half were at the remaining site in Houston that serves a more balanced racial/ethnic and higher sociodemographic population. Differences in general and specialist visits, hospital emergency room (ER) care, and hospitalizations were associated with race/ethnicity, income, and coverage. Logistic regression was used to assess the extent to which the differences persisted when adjusting for individual patient characteristics and site of care.
Compared to whites, blacks and Hispanics had higher rates of generalist visits [odds ratio (OR) = 5.3 and 4.9, p < 0.05), ER care (OR = 3.1 and 2.9, p < 0.05) and hospitalizations (OR = 5.4 and 6.2, p < 0.05), and lower rates of specialist visits (OR = 0.3 and 0.4, p < 0.05). A similar pattern was found related to patient income and coverage. The magnitude and significance of the disparities persisted when adjusting for individual characteristics but decreased substantially or were eliminated when site of care was added to the model.
There are sociodemographic disparities in health care for people with epilepsy that are largely explained by differences in where patients receive care.

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Available from: David Lairson, Oct 08, 2014
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    • "Other countries have looked at this question. A North American study [10] showed that African Americans and Hispanics had three times the rate of emergency room visits and five times the rate of hospitalization for seizures compared with Caucasian Americans. A Canadian study [11] revealed that Aboriginal patients with epilepsy were more likely than non-Aboriginal patients to present to an emergency department or to be hospitalized with seizures. "
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    • "A main objective is to engage patients and families in their own care by connecting them in meaningful ways to their health records and history in an effort to improve health outcomes [4] [5]. The MEW e-Tool development and dissemination framework seeks to provide equitable access to technology (including physical and network access) [32], appropriate content suitable for a patient's technological and health literacy skills [1] [2], and to demonstrate efficacy and effectiveness while acknowledging the demographic and socioeconomic challenges that mediate access to health care and epilepsy self-management programs [12] [33]. The MEW e-Tools are designed to complement traditional selfmanagement support for people with epilepsy and include the MEW website, WebEase, UPLIFT, MINDSET, PEARLS online training, and Texting 4 Control (developed independently by the Epilepsy Foundation , a MEW Network partner) (Fig. 1). "
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    • "Neurology services cannot deliver comprehensive care to all people with epilepsy [7] [8], and internationally, patients typically receive follow-up and monitoring of treatment and maintenance of antiepileptic drug (AED) prescriptions in primary care [1]. In the United Kingdom, general practice contributes to epilepsy care through the Qualities and Outcomes Framework (QOF) review [9] by implementing national guidelines [10] that encourage a management plan through partnership with patients and family. "
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