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Quality of Antiepileptic Treatment in Older Adults: Retrospective Study


October 11, 2017

In older adults with epilepsy, enzyme-inducing antiepileptic drugs (EI-AEDs) are not recommended. In addition, according to the Quality Indicator for Epilepsy Treatment 9 (QUIET-9)—a tool designed to benchmark the quality of care for adults with epilepsy in primary care and general neurology clinics—new patients should not receive EI-AEDs. However, racial and ethnic disparities in epilepsy care have been reported.

In a retrospective analysis of 2008-2010 Medicare claims, researchers investigated the use of EI-AEDs and provider concordance with QUIET-9. A 5% random sample of beneficiaries aged 67 years and older in 2009 were augmented for minority representation and analyzed. Logistic regressions were used to examine QUIET-9 concordance differences based on race/ethnicity, adjusting for socioeconomic, geographic, and individual factors.

Data analyzed included 21% white, 58% African American, 12% Hispanic, 6% Asian, 2% American Indian/Alaskan Native participants. Approximately 65% and 43.6% of cases used EI-AEDs in prevalent and new cases, respectively.
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QUIET-9 concordance was found for 71% Asian, 65% white, 61% Hispanic, 57% African American, 55% American Indian/Alaskan new cases: racial/ethnic differences were not significant in adjusted model. Beneficiaries without neurology care, in deductible drug benefit phase, or in high poverty areas were less likely to have QUIET-9 concordant care.

Based on these findings, authors concluded that EI-AED use is high and concordance with epilepsy recommendations is low among all racial/ethnic groups of older adults with epilepsy. Authors posit that socioeconomic disparities and drug coverage plans may impact treatment quality and opportunities to live well with the disease.—Amanda Del Signore

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