Improving Epilepsy Care in Ontario, Canada: The Impact of a Provincial Strategy for Epilepsy Care.

Abstract

Objective: In 2016, the Ontario Ministry of Health and Long-Term Care implemented the Provincial Strategy for Epilepsy Care to increase epilepsy surgery use in Ontario, Canada. The objectives of this study were to assess whether the use of (1) epilepsy surgery, including (a) its receipt and (b) assessments for candidacy, and (2) other healthcare for epilepsy, including (a) neurological consultations, (b) emergency department (ED) visits and (c) hospital admissions, changed since its implementation.

Methods: We used linked health administrative data and an interrupted time series design. Annual cohorts were created for July 1^st to June 30^th of each year from 2007 to 2019, comprising patients with drug-resistant epilepsy eligible for publicly funded prescription drug coverage with no cancer history. We used segmented Poisson regression models to assess whether the annual rates of each outcome changed between the period before the Provincial Strategy was implemented (July 2007-June 2016) and the period after.

Results: There was a level increase in the rate of epilepsy surgery of 48% (95% CI: 0%, 118%) and slope decreases in the rates of neurological consultations, ED visits and hospital admissions for epilepsy of 10% (95% CI: -15%, -5%), 10% (95% CI: -20%, 1%) and 7% (95% CI: -12%, -1%) per year, respectively, associated with the Provincial Strategy.

Conclusion: The Provincial Strategy may be associated with an increased rate of epilepsy surgery and reduced rates of other healthcare use for epilepsy. Other regions experiencing low epilepsy surgery rates may benefit from similar interventions.