Epilepsy - World Health Organization

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7 PRIMARY CARE 32 Introduction ◆ The respondents were asked to list the five main tasks of primary care workers involved in epilepsy care in the country. Ignoring the order of the individual responses, Salient findings ◆ Follow-up and monitoring of treatment is reported among the five main tasks of primary health workers involved in epilepsy care by 74% of the responding countries. This task includes monitoring of AED compliance and adverse effects. ◆ Maintenance or prescription of AEDs is mentioned among the five main tasks by 54.8% of the responding countries. ◆ Information and education of the patients and caregivers regarding epilepsy is described among the five main tasks of primary health workers by 50.7% of the responding countries. A few respondents also mentioned counselling regarding driving, social issues, pregnancy, school education for children with epilepsy, medico–legal advice, and training in basic first-aid and seizure prevention among the five main tasks of primary health workers involved in epilepsy care. ◆ Case-finding is reported among the five main tasks of primary health workers by 43.8% of the responding countries. Limitations ◆ The information is based on the experience and impression of a key person in a country working in the area of epilepsy and not on actual data from responding countries. ◆ The data report assessments by health professionals of the tasks performed by the primary care workers; it is possible that these may differ from the views of the primary care workers themselves. Conclusions ◆ Lack of access has been identified as a major barrier to adequate treatment in both high-income and low-income countries. Adequate training of the health workers providing first level of contact in case detection, initiation of treatment with AEDs (where local guidelines permit), follow-up and monitoring for compliance and adverse effects might be the most cost-effective way to decrease the treatment gap in the majority of countries. ◆ Primary health workers are the most appropriate choice for providing information and education to the patients, caregivers and the community as a whole about the disorder, the drugs and their side-effects, and the the proportion of countries that mentioned each task was calculated globally and for each of the regions. ◆ Referral of patients with epilepsy for confirmation of diagnosis, initiation of treatment, specialized investigations or specialist treatment for uncontrolled cases are also identified among the five main tasks of primary care workers by 46.6% of the responding countries. ◆ Psychosocial support and community rehabilitation (24% of the responding countries) and liaison with specialists and other services (13.7%) are also reported among the five main tasks of primary health workers involved in epilepsy care. ◆ Other tasks are also reported and include emergency treatment (10.3% of the respondents), initiation of treatment (9.6%) and maintenance of records (2.1%). ◆ Information and education of patients and caregivers regarding epilepsy is mentioned as one of the five main tasks by 69.1% of low-income countries compared with 37.5% of high-income countries. ◆ Information on the quality of services and their availability within each country was not obtained. ◆ Because the information was not obtained in a structured format, it might also underestimate some of the tasks performed by the primary care workers. implications and social issues involved. This role needs to be encouraged. ◆ <strong>Health</strong> service reforms are ongoing in many countries, which provides the policy-makers and planners with an opportunity to include adequate epilepsy care among the tasks of primary health workers. ◆ Community-based rehabilitation needs to be advocated for better integration and improved psychosocial functioning of the patient with epilepsy. ◆ Better liaison and referral network services between primary and secondary care are required to ensure the best possible care for the patient with epilepsy.
7.1 7.2 Main tasks of primary care workers involved in epilepsy care 74% Reported by countries (%) N=146 Follow-up and monitoring Main tasks of primary care workers involved in epilepsy care in different income groups of countries Lower middle Reported by countries (%) 69.6% N=46 50% 43.5% 41.3% 52.2% Maintenance of drugs Information and education 54.8% Referral 50.7% Case-finding 46.6% Support and rehabilitation 43.8% Liaison 24% Emergency treatment 75% High 73.8% Low 13.7% Initiation of treatment 53.1% N=32 N=42 57.1% 10.3% 9.6% Maintenance of records 37.5% 69.1% 56.3% 47.6% 43.8% 38.1% 2.1% Follow-up and monitoring Maintenance of drugs Information and education Higher middle PRIMARY CARE 7 78.3% N=23 Referral Case-finding 60.9% 43.5% 47.8% 43.5% 33
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Page 62 and 63: 20 60 LAY ASSOCIATIONS Introduction
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Demonstration Projects One of the m
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◆ Prevalence of epilepsy: proport
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36. Hauser WA. Should people be tre
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109. Kleinman A et al. The social c
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Country, territory or area Name Mad
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