Skip to main content

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.
Related Content
People With Epilepsy Report Higher Discrimination Rates than General Population
Epilepsy in Older Adults: Generic vs Brand Name Drugs

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

Back to Top