title: Quality care in epilepsy: Women's counseling and its association with folic acid prescription or recommendation.
abstract: OBJECTIVE
  This study aimed to determine if annual counseling about contraception and pregnancy in the setting of treatment for epilepsy is associated with increased recommending or prescribing of folate.
  
  
  METHODS
  This is a retrospective cohort study with medical record abstraction. We selected records from 77 women of childbearing age who had two or more visits for epilepsy at a neurology clinic. The assessment included a review of documentation from the first three visits for epilepsy within a 24-month follow-up window. We defined perfect adherence to annual counseling about the impact of epilepsy treatment on contraception or pregnancy as defect-free care for women (DFCW). A recommendation that the patient take over-the-counter folate or a prescription for folate was independently abstracted from the chart at each visit.
  
  
  RESULTS
  The group of patients who received DFCW (N=28, 36.36%) and the group who did not receive DFCW (N=49, 63.63%) were comparable with respect to age, disease duration, baseline history of drug-resistant epilepsy (DRE), presence of concurrent psychiatric disease, epileptologist involvement, number of antiepileptic drugs (AEDs) prescribed, seizure type, and etiology. Twenty (71.4%) patients in the DFCW group and 42 (85.7%) in the non-DFCW group were not recommended or prescribed folic acid (p=0.12).
  
  
  CONCLUSIONS
  Even with annual documentation of counseling about how epilepsy treatment may affect contraception and pregnancy, the "action" of prescribing or recommending folic acid during the ensuing 24months is frequently omitted.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: lidia.moura@mgh.harvard.edu.
authors.forename: Lidia M V R
authors.initials: LM
authors.lastname: Moura
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: dymendez@partners.org.
authors.forename: Diego Yacaman
authors.initials: DY
authors.lastname: Mendez
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: jdejesus5@partners.org.
authors.forename: Jonathan
authors.initials: J
authors.lastname: De Jesus
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: raandrade@partners.org.
authors.forename: Rogger A
authors.initials: RA
authors.lastname: Andrade
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA. Electronic address: dhoch@partners.org.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Hoch
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D003376:Counseling; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D006801:Humans; D008499:Medical Records; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011787:Quality of Health Care; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D005492:Folic Acid
keywords: Epilepsy Quality Measures; Epilepsy outcomes; Health-care reform; Pay for performance; Safety counseling; Women's counseling