Development of drug use indicators for epilepsy.

Abstract

Objective: To develop and use drug use indicators for epilepsy management. Design: Descriptive prospective (outpatient) and retrospective (inpatient) drug use indicator survey. Setting: Parirenyatwa Hospital epilepsy clinic and medical wards. Subjects: Random sample of 35 cases of status epilepticus and a prospective series of 31 patients attending the epilepsy clinic. Interventions: Indicators of drug use and patient care were developed and measured against national standard treatment guidelines (EDLIZ). Stock levels of all anti epileptic drugs (AEDs) were determined. Main Outcome Measures: Adherence to EDLIZ; utility of indicator measures. Results: For inpatients, average length of hospital stay was 8.7 days, with 60.0% adherence to EDLIZ. Less than half of the patients had an EEG performed and one third had an AED blood level measured. On discharge, patients were prescribed an average of 1.1 AEDs. Outpatient indicators showed good adherence to EDLIZ (89.2%) and an average of 1.2 AEDs drugs per prescription. Only 56.4% of prescribed drugs were actually dispensed. Most knew the dose and frequency of their medication but only 71.4% were aware of the expected duration of therapy. Conclusions: The use of the indicators provided a snapshot of epilepsy management and indicated that problems may exist in the use of EEGs and in drug supply at Parirenyatwa Hospital. Sensitivity of the indicators to change and across levels of care still needs to be determined.