Factors Associated With in Suboptimal Prescribing for Older Patients With Epilepsy

Condition(s) targeted: Epilepsy

Intervention: Phenytoin (Drug); Phenobarbital (Drug); Carbamazepine (Drug); Valproate (Drug); Gabapentin (Drug); Lamotrigine (Drug); topiramate (Drug); levetiracetam (Drug); oxcarbazepine (Drug); Zonisamide (Drug)

Phase: N/A

Status: Active, not recruiting

Sponsored by: Department of Veterans Affairs

Official(s) and/or principal investigator(s):
Mary Jo V Pugh, PhD RN, Principal Investigator, Affiliation: VA South Texas Health Care System, San Antonio

Nearly 2% of veterans >65 are actively treated for epilepsy, and the incidence is projected to increase with the aging of our society. Since commonly used antiepileptic drugs are considered suboptimal for older patients, it is important to understand existing patterns of treatment for older veterans with epilepsy.

Official title: Appropriateness of Antiepileptic Drug Use for Older Veterans

Study design: Retrospective

Detailed description: OBJECTIVE(S):

1. Identify patient, provider, and system factors predicting adoption of recommended AEDs for treatment of newly diagnosed older veterans (FY00-04).

2. Identify barriers to use of recommended AED in initial therapy for newly diagnosed older veterans with epilepsy.

3. Assess and compare effectiveness of long-term use of various AED.

METHODS:

Using existing national VA outpatient, inpatient, and pharmacy databases in conjunction with Medicare inpatient and outpatient standard analytic files, the 1999 National Health Survey of VA Enrollees, American Hospital Association data, and primary data collection, we will identify the extent to which treatment for older veterans newly diagnosed with epilepsy changed between FY00-FY04, and identify predictors of change at the patient, provider, and system levels. We will begin to identify barriers to use of recommended AED using structured interviews with primary care and general neurology providers in sites with high and low use of suboptimal AEDs in incident cases. Finally, we will compare hospitalizations, emergency room visits, and fall-related injuries (including fractures) for patients on different AED regimens.

RESULTS:

We have identified 72,638 patients who are at least 66 years of age, have a diagnosis of epilepsy in VA or Medicare files, and who also received AEDs from the VA; 9,682 of of these are incident cases, 41,867 are chronic cases, and 21,089 have been defined as having unknown onset. We found wide variations in prescribing, an high rates of use of suboptimal AEDs (70%). We identified sites with high and low use of suboptimal and new AEDs. We have finalized provider interview protocols, and are in the process of gaining approval at individual sites.

IMPACT:

The proposed study will enhance understanding of factors associated with adoption of clinical recommendations for newly diagnosed older patients with epilepsy, begin to identify barriers to their adoption, and assess outcomes of epilepsy patients on chronic AED therapy. This study will provide the foundation on which to develop interventions to improve care and will improve the quality of care for older veterans diagnosed with epilepsy.

Minimum age: 66 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

Veterans 66 years and older receiving care from the Veterans Health Administration between fiscal years 2000-2004 Diagnosis of epilepsy and receiving anticonvulsant drugs

Exclusion Criteria:

VA New England Health Care System, Bedford, Massachusetts 01730, United States

VA South Texas Health Care System, San Antonio, Texas 78229-5700, United States

Related publications:

Mortensen EM, Pugh MJ, Copeland LA, Restrepo MI, Cornell JE, Anzueto A, Pugh JA. Impact of statins and ACE inhibitors on mortality for subjects hospitalized with pneumonia. Eur Respir J. 2007 Oct 24; [Epub ahead of print]

Starting date: October 2000
Ending date: June 2008
Last updated: January 22, 2008