Nurse-led epilepsy follow-up clinic in India: is it feasible and acceptable to patients? A pilot study.
OBJECTIVE
India has an epilepsy treatment gap of up to 90%. Shortage of doctors, especially in rural communities makes getting epilepsy treatment almost impossible for the vast majority. Nurses are relatively more in number and available even in smaller cities and villages. This pilot study investigated if a nurse-led epilepsy follow-up clinic is feasible in India and is acceptable to patients.


METHODS
A II year Nursing postgraduate student was given 8h of didactic teaching tailored for epilepsy patient follow-up, followed by supervised observation time in the epilepsy clinic with a neurologist before conducting epilepsy follow-up clinics independently. Epilepsy patients ≥ 10 years of age and in follow-up for ≥ 6 months were included. They were independently followed-up both in the nurse-led clinic and in the neurologist's clinic. Outcome was measured in terms of interrater agreement (kappa) between the recommendations of the neurologist and the nurse in five domains. Patient satisfaction for nurse-led clinic was also evaluated.


RESULTS
The interrater agreement between the trained nurse and neurologist in following-up 175 enrolled patients was 76-94%; most unanimity (κ=94%) seen in identifying AED adverse effects while least agreement (κ=76%) was present regarding decisions to modify AED. The mean patient satisfaction score was 37.63 ± 3.26 (maximum possible score 40).


CONCLUSIONS
It is feasible for trained nurses to run epilepsy follow-up clinics in India and patients are likely to be satisfied with this approach.
College of Nursing, All India Institute of Medical Sciences, New Delhi, India.
Preethy
P
Paul
College of Nursing, All India Institute of Medical Sciences, New Delhi, India.
Meena
M
Agarwal
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Rohit
R
Bhatia
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Sreenivas
S
Vishnubhatla
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: mbsneuro@gmail.com.
Mamta Bhushan
MB
Singh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D017060:Patient Satisfaction; D010865:Pilot Projects; D057184:Practice Patterns, Nurses' / Q000639:trends*; D055815:Young Adult
Developing countries; Epilepsy follow-up; India; Nurse-led clinic; Treatment gap