No CrossRef data available.
Article contents
Improving Epilepsy Care in Ontario, Canada: The Impact of a Provincial Strategy for Epilepsy Care
Published online by Cambridge University Press: 31 January 2025
Abstract
Objective:
In 2016, the Ontario Ministry of Health and Long-Term Care implemented the Provincial Strategy for Epilepsy Care to increase epilepsy surgery use in Ontario, Canada. The objectives of this study were to assess whether the use of (1) epilepsy surgery, including (a) its receipt and (b) assessments for candidacy, and (2) other healthcare for epilepsy, including (a) neurological consultations, (b) emergency department (ED) visits and (c) hospital admissions, changed since its implementation.
Methods:
We used linked health administrative data and an interrupted time series design. Annual cohorts were created for July 1st to June 30th of each year from 2007 to 2019, comprising patients with drug-resistant epilepsy eligible for publicly funded prescription drug coverage with no cancer history. We used segmented Poisson regression models to assess whether the annual rates of each outcome changed between the period before the Provincial Strategy was implemented (July 2007–June 2016) and the period after.
Results:
There was a level increase in the rate of epilepsy surgery of 48% (95% CI: 0%, 118%) and slope decreases in the rates of neurological consultations, ED visits and hospital admissions for epilepsy of 10% (95% CI: −15%, −5%), 10% (95% CI: −20%, 1%) and 7% (95% CI: −12%, −1%) per year, respectively, associated with the Provincial Strategy.
Conclusion:
The Provincial Strategy may be associated with an increased rate of epilepsy surgery and reduced rates of other healthcare use for epilepsy. Other regions experiencing low epilepsy surgery rates may benefit from similar interventions.
Résumé
Améliorer les soins de l’épilepsie en Ontario (Canada) : l’incidence d’une stratégie provinciale de traitement de l’épilepsie.
En 2016, le ministère de la Santé et des Soins de longue durée de l’Ontario a mis en œuvre une stratégie provinciale de traitement de l’épilepsie pour accroître le recours au traitement chirurgical de cette maladie en Ontario (Canada). La présente étude visait à évaluer si : 1) le recours au traitement chirurgical de l’épilepsie, qui comprenait : a) la réception des demandes et b) l’évaluation de l’admissibilité des cas; et 2) celui à d’autres soins contre l’épilepsie, qui comprenait a) les consultations en neurologie; b) les visites aux services des urgences; et c) les hospitalisations, avaient évolué depuis la mise en œuvre du plan d’actions.
Nous avons utilisé des données administratives liées sur la santé et un devis à séries temporelles interrompues. Des cohortes annuelles ont été créées du 1er juillet au 30 juin de chaque année, de 2007 à 2019, comprenant des patients atteints d’épilepsie pharmacorésistante, admissibles à un régime public d’assurance-médicaments et exempts d’antécédents de cancer. Nous avons utilisé des modèles de régression de Poisson segmentée pour déterminer si les taux annuels de chaque critère d’évaluation avaient varié entre la période qui précédait la mise en œuvre de la stratégie provinciale (de juillet 2007 à juin 2016) et celle qui la suivait.
Nous avons constaté une augmentation de 48 % (intervalle de confiance [IC] à 95 % : de 0 % à 118 %) du recours au traitement chirurgical de l’épilepsie, et une diminution des taux de consultation en neurologie, de visite aux services des urgences et d’hospitalisation pour cause d’épilepsie, de 10 % (IC à 95 % : de -15 % à -5 %), de 10 % (IC à 95 % : de -20 % à 1 %) et de 7 % (IC à 95 % : de -12 % à -1 %) par année, respectivement, associée à la mise en œuvre de la stratégie provinciale.
La stratégie provinciale serait associée à un recours accru au traitement chirurgical de l’épilepsie et à une diminution du recours aux autres types de soins contre l’épilepsie. Peut-être que les régions dans lesquelles il y a un faible recours au traitement chirurgical de l’épilepsie pourraient tirer profit d’interventions similaires.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation
References
World Health Organization. Epilepsy: A public health imperative [Internet]. Geneva, 2019: 1–171. Available from: https://www.who.int/publications/i/item/epilepsy-a-public-health-imperative.Google Scholar
Berto, P. Quality of life in patients with epilepsy and impact of treatments. Pharmacoeconomics. 2002;20(15):1039–1059.CrossRefGoogle ScholarPubMed
Thurman, DJ, Logroscino, G, Beghi, E, et al. The burden of premature mortality of epilepsy in high-income countries: a systematic review from the mortality task force of the international league against epilepsy. Epilepsia. 2017;58(1):17–26.CrossRefGoogle ScholarPubMed
Keezer, MR, Sisodiya, SM, Sander, JW. Comorbidities of epilepsy: current concepts and future perspectives. Lancet Neurol. 2016;15(1):106–115.Google ScholarPubMed
Baranowski, CJ. The quality of life of older adults with epilepsy: a systematic review. Seizure. 2018;60:190–197. doi: 10.1016/j.seizure.2018.06.002.CrossRefGoogle ScholarPubMed
Taylor, RS, Sander, JW, Taylor, RJ, Baker, GA. Predictors of health-related quality of life and costs in adults with epilepsy: a systematic review. Epilepsia. 2011;52(12):2168–2180.Google ScholarPubMed
Kalilani, L, Sun, X, Pelgrims, B, Noack-Rink, M, Villanueva, V. The epidemiology of drug-resistant epilepsy: a systematic review and meta-analysis. Epilepsia. 2018;59:2179–2193.CrossRefGoogle ScholarPubMed
Kwan, P, Arzimanoglou, A, Berg, AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc task force of the ILAE commission on therapeutic strategies. Epilepsia. 2010;51(6):1069–1077.Google Scholar
Wiebe, S, Blume, W, Girvin, JP, Eliasziw, M. A randomized, controlled trial of surgery for temporal lobe epilepsy. N Engl J Med. 2001;345(5):311–318.Google ScholarPubMed
Perucca, P, Scheffer, IE, Kiley, M. The management of epilepsy in children and adults. Med J Aust. 2018;208(5):226–233.Google ScholarPubMed
López González, FJ, Rodríguez Osorio, X, Gil-Nagel Rein, A, et al. Drug-resistant epilepsy: definition and treatment alternatives. Neurología. 2015;30(7):439–446.CrossRefGoogle ScholarPubMed
Yoo, JY, Panov, F. Identification and treatment of drug-resistant epilepsy. Contin Lifelong Learn Neurol. 2019;25(2):362–380.CrossRefGoogle ScholarPubMed
Epilepsy Implementation Task Force. Provincial guidelines for epilepsy surgery referrals in Ontario [Internet]. 2016. Available from: https://epilepsysco.org/resources/provincial-guidelines-for-epilepsy-care-in-ontario/
Google Scholar
Cross, JH, Jayakar, P, Nordli, D, et al. Proposed criteria for referral and evaluation of children for epilepsy surgery: recommendations of the subcommission for pediatric epilepsy surgery. Epilepsia. 2006;47(6):952–959.CrossRefGoogle ScholarPubMed
Statistics Canada. Table 17-10-0005-01 population estimates on July 1st, by age and gender. 2022. Available from: www150.statcan.gc.ca
Google Scholar
Burneo, JG, Liu, K, Leonard, S, Saposnik, G. Disparities in surgery among patients with intractable epilepsy in a universal health system. Neurology. 2016;86:72–78.CrossRefGoogle Scholar
Epilepsy Implementation Task Force. Provincial guidelines for the management of epilepsy in adults and children [Internet]. 2015. Available from: https://epilepsysco.org/resources/provincial-guidelines-for-epilepsy-care-in-ontario/
Google Scholar
Epilepsy South Central Ontario. Provincial guidelines for epilepsy care in Ontario [Internet]. 2022. Available from: https://epilepsysco.org/resources/provincial-guidelines-for-epilepsy-care-in-ontario/
Google Scholar
Esri. World light gray base [Map] [Internet]. 2022. Available from: https://doc.arcgis.com/en/data-appliance/7.2/maps/world-light-gray-base.htm
Google Scholar
Esri Canada. Provinces and territories of Canada [Map layer] [Internet]. 2024. Available from: https://hub.arcgis.com/datasets/d3fef65386df4e63b02d6e23bb98a1ee_0/about
Google Scholar
Ministry of Health. Get coverage for prescription drugs [Internet]. 2023. [cited 2023 Jul 20]. Available from: https://www.ontario.ca/page/get-coverage-prescription-drugs
Google Scholar
Ministry of Health and Long-Term Care: Drugs and Devices Division. OHIP+ Redesign update - FAQs for patients [Internet]. Available from: https://www.health.gov.on.ca
Google Scholar
Tu, K, Wang, M, Jaakkimainen, RL, et al. Assessing the validity of using administrative data to identify patients with epilepsy. Epilepsia. 2014;55(2):335–343.Google ScholarPubMed
Taljaard, M, McKenzie, JE, Ramsay, CR, Grimshaw, JM. The use of segmented regression in analysing interrupted time series studies: An example in pre-hospital ambulance care. Implement Sci. 2014;9(1):1–4.CrossRefGoogle ScholarPubMed
Xiao, H, Augusto, O, Wagenaar, BH. Reflection on modern methods: a common error in the segmented regression parameterization of interrupted time-series analyses. Int J Epidemiol. 2021;50(3):1011–1015.Google ScholarPubMed
Hawley, S, Ali, MS, Berencsi, K, Judge, A, Prieto-Alhambra, D. Sample size and power considerations for ordinary least squares interrupted time series analysis: a simulation study. Clin Epidemiol. 2019;11:197–205.CrossRefGoogle ScholarPubMed
Bowen, JM, Snead, OC, Chandra, K, Blackhouse, G, Goeree, R. Epilepsy care in Ontario: an economic analysis of increasing access to epilepsy surgery. Ont Health Technol Assess Ser. 2012;12(18):1–41.Google ScholarPubMed
Wiebe, S, Gafni, A, Blume, WT, Girvin, JP. An economic evaluation of surgery for temporal lobe epilepsy. J Epilepsy. 1995;8(3):227–235.CrossRefGoogle Scholar
Widjaja, E, Li, B, Schinkel, CD, et al. Cost-effectiveness of pediatric epilepsy surgery compared to medical treatment in children with intractable epilepsy. Epilepsy Res. 2011;94(1-2):61–68.Google ScholarPubMed
Widjaja, E, Demoe, L, Yossofzai, O, et al. Health care system costs associated with surgery and medical therapy for children with drug-resistant epilepsy in Ontario. Neurology. 2022;98(12):E1204–E1215.CrossRefGoogle ScholarPubMed
Yossofzai, O, Biswas, A, Moineddin, R, et al. Number of epilepsy surgeries has decreased despite an increase in pre-surgical evaluations at a tertiary pediatric epilepsy center in Ontario. Seizure. 2023;108:1–9. doi: 10.1016/j.seizure.2023.04.001.Google Scholar
Project ECHO. Epilepsy across the lifespan [Internet]. 2024. [cited 2024 Feb 8]. Available at: https://oen.echoontario.ca/
Google Scholar
Antaya et al. supplementary material
Antaya et al. supplementary material
File
52 KB