Review Article Evidence-based models of care for people with epilepsy Mary Fitzsimons a, ⁎, Charles Normand b , Jarlath Varley a , Norman Delanty a a Epilepsy Programme, Beaumont Hospital, Dublin, Ireland b Department of Health Policy and Management, Trinity College, Dublin, Ireland abstract article info Article history: Received 17 October 2011 Accepted 18 October 2011 Available online 30 November 2011 Keywords: Chronic disease management Patient self-management Integrated care Epilepsy specialist nurse Epilepsy care guidelines Health information technology Primary care Advances in medical science and technology, together with improved medical and nursing care, are continu- ously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article. © 2011 Elsevier Inc. All rights reserved. 1. Introduction As for other chronic conditions, the diagnosis and management of epilepsy rely on contributions from a number of health care disci- plines in a variety of health care settings, for example, community- based general practice, secondary, and tertiary care. However, the frag- mented nature of health services can often lead to uncoordinated care, inconsistent advice for the patient, inappropriate or unnecessary in- vestigations, and delays in diagnosis and initiation of treatment [1]. All of this poses a significant challenge to achieving optimal ep- ilepsy care and management [2–4]. Although most patients with epilepsy in high-income countries receive some form of therapy, significant geographic and socioeco- nomic inequities in access to care and treatment for epilepsy- related complications exist [5]. Consequently many patients do not receive the proper care in the appropriate setting. In addition, there are significant opportunity costs associated with unnecessary hospital admissions because of seizures, epilepsy misdiagnosis, inappropriate use of accident and emergency resources, and poor antiepileptic drug prescribing [6,7]. In response to the challenge of maximizing the benefits of medical advances for the patient while minimizing the burden on health care systems, there is an international move to transform the way chronic disease is managed. The transformation aims to move from the episodic reactive model of health care delivery to one that prevents the occurrence of disease, averts or delays further deterioration, and improves the health and quality of life of those already suffering from the condition [3,8]. To achieve the transformation, the recom- mendations of chronic disease management (CDM) models include (Fig. 1): • Promotion of patients’ active participation in managing their health • Development of shared care that is integrated across organizational boundaries • Implementation of guidelines that support clinical management decisions • Use of clinical information systems, such as electronic health records, to provide timely access to comprehensive patient information to those who deliver and receive care. The application of these recommendations and evidence of their effectiveness in epilepsy care are discussed in this review. The classi- fication system outlined in Table 1 was used to score the level and grade of evidence [9]. Some of the studies considered here have pre- viously been included in systematic reviews in which models of care for people with epilepsy [10] and long-term neurological conditions [11] have been evaluated. 2. Patient education and self-management Increased attention is being paid to the development of self- management in many chronic illnesses. Empowering patients to take a more active role in their care is likely to improve understanding of their illness, increase compliance with treatment regimes, and encourage adoption of healthier lifestyles. In epilepsy the result will be better awareness and management of the stressors that trigger Epilepsy & Behavior 23 (2012) 1–6 ⁎ Corresponding author at: Epilepsy Programme, Beaumont Hospital, Dublin 9, Ireland. E-mail address: maryfitzsimons@beaumont.ie (M. Fitzsimons). 1525-5050/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2011.10.019 Contents lists available at SciVerse ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh