Self-management of Epilepsy: A Systematic Review
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2019
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Epilepsy affects about 50 million people worldwide. In the Veterans Health Administration (VHA), an estimated 79,576 Veterans were treated for epilepsy in 2016. Seizure control and medication adherence are common challenges among patients; decreased health care literacy, poor social support, burdensome side effects, low socioeconomic status, and co-occurring psychiatric disorders are all associated with lower medication adherence. Patient self-management behaviors are important to the management of epilepsy, as decreased patient participation in treatment regimens is a major cause of breakthrough seizures, leading to increased hospital utilization and mortality. In 2003, the Institute of Medicine defined self-management support as “the systematic provision of education and supportive interventions by health care staff to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support.” In Veterans Affairs (VA), self-management has an established role in the management of chronic conditions, such as diabetes mellitus, chronic obstructive pulmonary disease, and depressive disorders. For patients with epilepsy, improved self-management skills could improve self-efficacy, medication adherence, avoidance of seizure triggers, and improve patient and family knowledge about when to seek urgent medical care. A Cochrane review that included literature published through December 2013 evaluated self-management strategies for adults with epilepsy. The review identified only 4 trials and concluded that self-management education has some evidence of benefit but did not find clear evidence of substantially improved outcomes for adults with epilepsy. Prior systematic reviews on this topic were inadequate for the needs of our stakeholders because they do not include recent important studies and did not adequately consider components such as peer support, which has particular relevance to Veterans. This review will address these gaps in evidence, synthesize the current evidence on self-management programs for patients with epilepsy, and identify potential barriers in the adoption of these programs within the VHA system.
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Luedke, Matthew W, Dan V Blalock, Allison A Lewinski, Abigail Shapiro, Connor Drake, Jeffrey D Lewis, Karen M Goldstein, Aatif M Husain, et al. (2019). Self-management of Epilepsy: A Systematic Review. 10.7326/m19-0458 Retrieved from https://hdl.handle.net/10161/34657.
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Scholars@Duke
Matthew William Luedke
I have diverse research interests and collaborations. Clinical research interests include epilepsy quality-of-life interventions and therapeutics and acute care neurological issues like post-cardiac arrest management and quality-of-care issues. I work with the Duke hyperbaric chamber team on clinical neurophysiological monitoring of ketone-related research.
Jennifer M. Gierisch
Jennifer Gierisch, PhD, is behavioral scientist and health services researcher. She is an Associate Professor in the Department of Population Heath Sciences and the Department of Medicine at Duke University. She is a core investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) where she serves as the leader of the Partnered Research Methods Core (PRESTO) and Director of the VA OAA Health Services Research Postdoctoral Fellowship. Dr. Gierisch also is the Co-Director of the Evidence Synthesis Program (VA ESP) at the Durham Veteran Affairs Health Care System. She also served as a faculty director of the Duke Clinical Translational Science Institute's Community Engaged Research Initiative (CeRi) for five years
Dr. Gierisch’s research focuses on three overarching areas: 1) behavioral research on the psychosocial factors that influence appropriate uptake and maintenance of complex health behaviors (eg., weight management, smoking cessation, cancer screening); 2) evidence synthesis on key health and healthcare topics to enhance uptake of evidence-based interventions to improve patient and health system outcomes; and 3) participatory and community engaged research approaches.
Area of expertise: health behavior, community-engaged research, evidence synthesis, intervention development, qualitative research
Tung T Tran
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
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