Patients with epilepsy must be managed continuously to ensure that resources are used appropriately. The goal of this approach is to prevent complications and acute events, minimise long term health problems and avoid adverse effects of the condition or its treatment. Several different models of care may be used for patients with epilepsy. One model uses primary care physicians for most care; another risk-stratifies patients and assigns serious or unstable cases to specialists who act as their primary care physicians until the patients are stabilised adequately; a third integrates these 2 approaches, with the primary care physician and specialist jointly responsible for coordination of care and communication with the patient. All 3 approaches can be cost effective. With each approach, case management is critical to continuity of care in both inpatient and ambulatory settings.
Managed care organisations must be committed to a systems approach that combines medical management and psychosocial support by healthcare professionals and a patient’s family. Such a strategy will best identify and address problems in all areas of a patient’s life — medical, behavioural, academic and work related. Pharmacotherapy in epilepsy must balance treatment efficacy, tolerability, safety, ease of use and cost. Decisions regarding the cost effectiveness of pharmacotherapy should consider not only the acquisition costs of drugs, but also efficacy and incidence of adverse events. Making a commitment to involving the patient as an educated partner in decision-making not only increases compliance but also reduces the costs of treatment.
Adis International Limited Primary Care Physician Antiepileptic Drug Vigabatrin Primidone
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