Outpatient visit behavior in patients with epilepsy: Generalized Epilepsy is more frequently non-attendance than Focal Epilepsy

Yuichi Nakamura; Kotaro Sakurai; Shuhei Ishikawa; Toru Horinouchi; Naoki Hashimoto; Ichiro Kusumi

doi:10.1016/j.yebeh.2023.109345

Outpatient visit behavior in patients with epilepsy: Generalized Epilepsy is more frequently non-attendance than Focal Epilepsy

Epilepsy Behav. 2023 Aug:145:109345. doi: 10.1016/j.yebeh.2023.109345. Epub 2023 Jul 11.

Authors

Yuichi Nakamura¹, Kotaro Sakurai², Shuhei Ishikawa³, Toru Horinouchi³, Naoki Hashimoto³, Ichiro Kusumi³

Affiliations

¹ Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan. Electronic address: y_nakamura@pop.med.hokudai.ac.jp.
² Department of Neuropsychiatry, Aichi Medical University, 1-1, Karimata, Yazako, Nagakute-shi, Aichi 480-1195, Japan.
³ Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan.

PMID: 37441983
DOI: 10.1016/j.yebeh.2023.109345

Abstract

Background: Patients with epilepsy (PWE), especially those with Idiopathic Epilepsy (GE), are at a high risk of disadvantage caused by non-adherence. It has been suggested that medical visit behavior may be a surrogate indicator of medication adherence. We hypothesized that patients with IGE would adhere poorly to visits.

Methods: This was a retrospective study of PWE who visited the Department of Psychiatry and Neurology at Hokkaido University Hospital between January 2017 and December 2019. Demographic and clinical information on PWE were extracted from medical records and visit data from the medical information system. Non-attendance of outpatient appointments was defined as "not showing up for the day of an appointment without prior notice." Mixed-effects logistic regression analysis was conducted with non-attendance as the objective variable.

Results: Of the 9151 total appointments, 413 were non-attendances, with an overall non-attendance rate of 4.5%. IGE was a more frequent non-attendance than Focal Epilepsy (FE) (odds ratio (OR) 1.94; 95% confidence interval (CI) 1.17-3.21; p = 0.010). History of public assistance receipt was associated with higher non-attendance (OR 2.04; 95% CI 1.22-3.43; p = 0.007), while higher education (OR 0.64; 95% CI 0.43-0.93; p = 0.021) and farther distance to a hospital (OR 0.33; 95% CI 0.13-0.88; p = 0.022), and higher frequency of visits (OR 0.18; 95% CI 0.04-0.86; p = 0.031) were associated with fewer non-attendances. In a subgroup analysis of patients with GE, women were associated with fewer non-attendance (OR 0.31; 95% CI 0.14-0.72; p = 0.006).

Conclusions: GE was more frequent in the non-attendance group than in the FE group. Among patients with GE, females were found to have non-attendance less frequently; however, there was no clear difference in the odds of non-attendance between Juvenile Myoclonic Epilepsy (JME) and IGE other than JME.

Keywords: Idiopathic Generalized Epilepsy; Non-attendance; Outpatient visit behavior; Personality traits; Poor adherence.

MeSH terms

Epilepsies, Partial*
Epilepsy, Generalized*
Female
Humans
Immunoglobulin E / therapeutic use
Myoclonic Epilepsy, Juvenile* / drug therapy
Outpatients
Retrospective Studies

Substances

Immunoglobulin E