title: The assessment and management of adult patients with epilepsy--the role of general practitioners and the specialist services.
abstract: Recommendations have been made that all patients developing seizures should be referred to specialist services for full investigation and assessment and re-referred for issues such as inadequate seizure control, consideration of drug withdrawal and for pre-conceptual counselling. Bristol area general practitioners (GPs) were sent a questionnaire to determine their referral practices for adult patients with epilepsy. Details of their current management of these patients and their requirements from the specialist services were also obtained. Questionnaires were completed and returned by 67.8% of the GPs. Most referred their patients to the neurological or neuropsychiatric services. More than 70% wanted their new patients to be assessed within 4 weeks. Approximately, half at least sometimes treated their patients before this assessment of which a third never or only rarely sought advice as to the most suitable anticonvulsant. Most (71.5%) believed they had consultations with their patients with epilepsy at least yearly; however, only 34.3% had a recall system for non-attendees. Two-thirds either currently audited their practices or were willing to consider doing so, and 64.4% recognized a need for regular seminars on epilepsy. Few welcomed the introduction of joint clinics but two thirds believed co-operation cards could be useful. GPs in practices with an epilepsy nurse specialist were more supportive of the use of co-operation cards and were more likely to be involved in audit. Recommendations to improve the care provided by the Primary Health Care teams and aid communications with the specialist epilepsy services are made.
authors.affiliation: Department of Psychological Medicine, Section of Neuropsychiatry, Institute of Psychiatry and GKT Medical School, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
authors.forename: M V
authors.initials: MV
authors.lastname: Lambert
authors.forename: J M
authors.initials: JM
authors.lastname: Bird
mesh_terms: D000328:Adult; D004827:Epilepsy / Q000453:epidemiology*; D006801:Humans; D008511:Medicine / Q000706:statistics & numerical data*; D009462:Neurology / Q000706:statistics & numerical data; D009720:Nurse Clinicians / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010819:Physician's Role; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013038:Specialization; D011795:Surveys and Questionnaires