Perspectives from a developed nation.
Epilepsy is the most common serious neurologic disorder, affecting 350,000 people in the United Kingdom. There are five neurologists per 1,000,000 population, which is better than in India but much lower than in other developed nations. Thus, a patient's day-to-day prescribing, supervision, and support depends on primary care. In the U.K., patients are entitled to register with a general practitioner (GP), who has an average of 1,841 patients. Seventy-eight percent of patients will consult their GP annually. Patients in the U.K. find that GPs are accessible and have good communication skills. There is, however, inadequate time in short consultations to provide the quality of care suggested by the latest review of services for patients with epilepsy (CSAG). This is further complicated by the heterogeneous and stigmatising nature of the condition. An improvement in the process of care in the primary-care setting can result from three important strategies: appropriately trained practice nurses running practice nurse-led clinics; structured management of care, possible because of the unique system of registration, which facilitates audit, prescription monitoring, and recall; and, finally, improved teamwork and communication based on protocols locally agreed upon between primary and secondary care. The future will tell whether these initiatives will improve the outcomes of care.
Redhead
Keith
K
St. James Medical Practice, King's Lynn, United Kingdom. keith@redheadk.freeserve.co.uk
D019049:Developed Countries; D004827:Epilepsy / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D009462:Neurology / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*