Office visits featured more discussion regarding adverse drug effects and mood and behavioral issues without increasing the length of visit.
BOSTON—Use of a previsit assessment tool can increase the amount of discussion regarding adverse effects of antiepileptic drugs (AEDs) and accompanying mood or behavioral issues without increasing the length of routine visits for patients with epilepsy, according to research presented at the 63rd Annual Meeting of the American Epilepsy Society.
John M. Stern, MD, an Associate Professor of Medicine at the David Geffen School of Medicine, University of California, Los Angeles, and colleagues conducted an in-office linguistic research study (phase I) of naturally occurring interactions between 20 community-based neurologists and patients with epilepsy, which revealed limited assessments of adverse effects associated with AEDs, as well as mood and behavioral problems.
A follow-up study (phase II) was conducted to determine if and how neurologists could incorporate a previsit assessment tool that was based on elements from the Adverse Events Profile and Neurological Disorders Depression Index in Epilepsy screening tool. The previsit assessment tool was designed to capture background information (seizure frequency, medication regimen), frequency of adverse effects associated with AEDs throughout the past month, and how frequently a patient experienced six aspects of depression during the previous two weeks.
Discussions between the neurologists and 60 of their patients were recorded. Both parties were interviewed separately, postvisit, to document their perceptions of the visit. On average, each neurologist saw three patients. Dialogue components were transcribed and analyzed using validated sociolinguistic models. The phase II results were compared with previous outcomes from phase I. Primary end points included the frequency of discussions on adverse effects and on mood or behavior issues.
Frequency of Adverse Effects Discussions
“Visits in which the previsit assessment tool was used included statistically significant increases in discussions about adverse effects and mood and behavior issues, which affect most patients,” Dr. Stern and colleagues reported.
“Adverse effects were discussed more often (6.0 vs 4.0 per visit on average) and in a higher proportion of visits (100% vs 75%) with patients on AEDs in phase II than in phase I,” the authors stated. “Adverse effect conversations continued to be initiated more often by neurologists. Patients confirmed a greater proportion of adverse effects in phase II.” Compared with phase I, an increase was observed in discussions that assessed three or more adverse events lasting longer than 60 seconds (89% vs 57% of visits).
The researchers also found that neurologists and patients mentioned mood and behavior problems more frequently in phase II than in phase I (90% vs 23%, respectively). “The average number of mood- and behavior-related issues discussed per visit increased from 2.0 in phase I to 4.7 in phase II,” they reported.
Alignment on Presence of Comorbidities
The researchers also found that neurologists and patients mentioned mood and behavior problems more frequently in phase II than in phase I (90% vs 23%, respectively). “The average number of mood- and behavior-related issues discussed per visit increased from 2.0 in phase I to 4.7 in phase II,” they reported.
The analysis also included secondary end points, such as alignment on presence of adverse effects, as well as presence of mood and behavioral problems and length of visit. Seventy-six percent of physician–patient pairs agreed that adverse effects were present in phase II, compared with 12% in phase I. In addition, 80% of physician–patient pairs agreed that mood and behavioral issues were present in phase II, compared with 40% in phase I. Furthermore, the median length of visit of phase I was 10.63 minutes; no statistical difference regarding length of visit was seen between phase I and phase II, despite the changes in the content of the discussions.
“Linguistic analyses of in-office dialogue and postvisit interviews revealed measurable improvements in several areas, likely attributable to use of the previsit assessment tool,” Dr. Stern and colleagues concluded. “The tool focuses visit discussions on critical issues and gives neurologists valuable information, helping to individualize treatment decisions and optimize patient care.”
—Laura Sassano