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. 2019 Mar 6;4(2):264-274.
doi: 10.1002/epi4.12311. eCollection 2019 Jun.

A home-based, primary-care model for epilepsy care in India: Basis and design

Gagandeep Singh  1   2   3 , Suman Sharma  2 , Rajnder K Bansal  1 , Raj K Setia  4 , Sarit Sharma  5 , Namita Bansal  2 , Anuraag Chowdhury  5 , Jatinder S Goraya  6 , Susmita Chatterjee  7 , Sukhpreet Kaur  2 , Manpreet Kaur  2 , Shivani Kalra  8 , Josemir W Sander  3   9   10
Affiliations

A home-based, primary-care model for epilepsy care in India: Basis and design

Gagandeep Singh et al. Epilepsia Open. .

Abstract

Objectives: A cluster-randomized trial of home-based care using primary-care resources for people with epilepsy has been set up to optimize epilepsy care in resource-limited communities in low- and middle-income countries. The primary aim is to determine whether treatment adherence to antiepileptic drugs is better with home-based care or with routine clinic-based care. The secondary aims are to compare the effects of the two care pathways on seizure control and quality of life.

Methods: The home-based intervention comprises epilepsy medication provision, adherence reinforcement, and epilepsy self-management and stigma management guidance provided by an auxiliary nurse-midwife equivalent. The experimental group will be compared to a routine clinic-based care group using a cluster-randomized design in which the unit of analysis is a cluster of 10 people with epilepsy residing in an area cared for by a single accredited government grass-roots health care worker. The primary outcome is treatment adherence as measured by monthly tablet counts supplemented by two self-completed questionnaires. The secondary outcomes include monthly seizure frequency, time to first seizure (in days) after enrollment, proportion of patients experiencing seizure freedom for the duration of the study, and quality of life measured by the "Personal Impact of Epilepsy Scale," all assessed by an independent study nurse.

Results: The screening phase and neurologic evaluations and randomizations have been recently completed and follow-up is underway.

Significance: The results of the trial are likely to have substantial bearing on the development of governmental policies and strategies to provide coverage and care for patients with epilepsy in resource-limited countries.

Keywords: adherence; cluster‐randomized trial; community; epilepsy; primary care.

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Conflict of interest statement

The authors declare no conflict of interest in relation to this work. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Figures

Figure 1
Figure 1
A, Map of the study area with division in to nine immunization zones. The primary health centers, district hospitals, and two private medical college hospitals are also mapped. B, Map of a randomly chosen screening cluster depicting the progress of door‐to‐door screening
Figure 2
Figure 2
Trial flow chart depicting screening, evaluation, randomization, and assessments
Figure 3
Figure 3
Trial assessment schedules
See this image and copyright information in PMC

References

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