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|Issue 148||March 2019|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Self-Management of Epilepsy: A Systematic Review
Epilepsy is a neurological disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Epilepsy affects about 50 million people worldwide and is one of the most common chronic neurological conditions, with the potential to generate significant morbidity, impaired quality of life, socioeconomic decline, and high healthcare costs. In 2016, an estimated 79,576 Veterans were treated for epilepsy in the VA healthcare system; almost half were 65 years of age or older. Self-management is essential for many patients who live with a chronic disease, and the VA and other health systems are interested in offering self-management training to patients with epilepsy. Improved self-management skills could improve medication adherence, avoidance of seizure triggers, and improve patient and family knowledge about when to seek urgent medical care.
Self-management training helps people learn about their illness, and may involve symptom monitoring, medication management, learning problem-solving and decision-making skills, safety promotion, or changing physical activity, dietary, and/or smoking behaviors.
The current systematic review was requested by VA's National Neurology Program Office in the Office of Specialty Care Services, which is responsible for policies and programs for neurological disorders in VA nationally. The review will be used to identify the current evidence base and its quality to support the use of self-management programs aimed at patients with epilepsy, and to identify potential barriers in the adoption of these programs within VA. Investigators with VA's Evidence-based Synthesis Coordinating Center in Durham, NC reviewed the literature including: MEDLINE®, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL from inception to 4/13/18. Investigators identified 15 studies that examined the effects of self-management for epilepsy (including 13 randomized controlled trials and 2 non-randomized trials; 2,514 patients) and 13 studies that addressed the implementation and adoption of interventions. No studies directly addressed implementation and adoption issues for large health systems such as VA.
Summary of Review
Tested interventions for the self-management of epilepsy were deemed to fit into two categories:
Findings on facilitators and barriers to intervention implementation were stronger and point to a clearer path to the design and adoption of self-management interventions, including factors of patient personalization, information delivery, use of technology, and intervention personnel. For example, the role of the clinician is important to the implementation of the intervention. The clinician should be appropriately trained, have the duties of the intervention incorporated into their dedicated clinical time, and be provided with clearly written, standardized protocols that articulate the clinician's role in the intervention.
The most recent study included in this systematic review — the SMART intervention by Sajatovic and colleagues — enrolled Veterans and is an example of a well-structured and well-reported study, which included healthcare utilization and safety outcomes that were not reported in other studies (Sajatovic et al, 2018). Future investigators should consider the SMART trial as a model for study design, and sources of research support could use it as a guide for funding subsequent work in epilepsy self-management.
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.
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