Evaluation of a primary care epilepsy specialist nurse service
This thesis reports on an evaluation of an intervention to improve the quality of care for adults with epilepsy. The intervention comprised an epilepsy specialist nurse working in 14 general practices in north west Bristol, England. A multi-method approach was employed. As part of a quasi-experimental trial, baseline and two annual follow-up questionnaires were sent to all patients in the practices aged 16 years and over and currently on drugs for epilepsy. In addition, interviews were undertaken with those having seizures to explore further some questionnaire findings and to appraise the appropriateness, acceptability and accessibility of the nurse service. The epilepsy nurse was interviewed to assess the feasibility of providing the new service. Baseline results highlighted deficiencies in services for people with epilepsy and suggested the need for structured care and increased discussion. The main effects of the nurse service were improved communication about epilepsy between health care providers and patients and increased access, especially for those with the greatest needs. The nurse service had limited impact on patients’ health status. There were indications of a negative impact on the perceived effect of epilepsy on aspects of everyday life. After one year, an intention-to-treat analysis suggested improvements in satisfaction with care from GPs, but decreased adherence to medication. A comparison of nurse service users with non-users after two years showed a reduction in the use of polypharmacy in users, and an increased proportion who queried GPs’ knowledge about epilepsy. Users reported increased visits to their GP. Interview data showed that the decision to use the nurse service depended on factors other than the severity and frequency of seizures. The service was most appropriate for those who perceived themselves to need care or information. This method of delivering care was feasible, but several operational problems were identified. The study supports the use of specialist nurses in primary care. Impact is, however, limited. The greatest contribution to improving care is by supporting and advising patients with specific and defined needs.