Quality of care of epilepsy in Italy: multi-hospital survey of diagnosis and treatment of 1104 epileptic patients.
We surveyed the treatment of 1104 patients admitted to 27 out of the 46 departments of neurology (64.5%), neurosurgery (23.0%), and child neurology (12.5%) of Lombardy, the largest Italian Region (population, 9,000,000). Our main aim was to assess the penetration of correct diagnostic and clinicopharmacological information into routine practice. A detailed analysis and discussion are given to data concerning reasons for hospital admission (therapeutic adjustment accounting for 27.3%; diagnostic ascertainment, 53.8%); characteristics of the disease, in terms of duration, clinical manifestations, and pattern of seizures; associated disorders; prevalence and criteria for the use of instrumental diagnostic procedures (EEG, brain scan, computed tomography, etc.); pattern of prescriptions of anticonvulsant drugs at admission and at discharge, with particular emphasis on specific drug choices by specialty; prevalence of single-drug therapy (41% at admission and 47.0% at discharge) versus polytherapy; degree of correspondence between recommended and observed dosage regimens (undertreatment being a more common problem than excessive dosing); and reporting of side effects. Although some of the findings of some recent studies are confirmed, this report documents the feasibility of a regular audit program of the performance of an entire health care system in the treatment of epilepsy.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006306:Health Surveys; D006761:Hospitals; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000008:administration & dosage; D010672:Phenytoin / Q000008:administration & dosage; D011787:Quality of Health Care
D000927:Anticonvulsants; D010672:Phenytoin; D010634:Phenobarbital