Community Epilepsy Outreach Service
Community Epilepsy Outreach Service, based in Cork, has succeeded in transforming the quality of epilepsy care for service users through a radical redesign of the model of care.
The service was established in 2014 to provide high-quality specialist epilepsy care to people with intellectual disabilities living in residential care. Dr Daniel Costello Consultant Neurologist/Epileptologist and Dr Ronan McGinty, Epilepsy Registrar visit clients in their home environment and provide ongoing telephone-based care in between visits.
The service currently visits ten residential sites on a rotating basis and over 200 clients have been assessed to date. The sites are run by COPE Foundation, Brothers of Charity and St Raphael’s.
Approximately 50% of people with moderate-severe intellectual disability have epilepsy which can be treatment resistant and highly complex to manage. People with intellectual disabilities living in residential care settings often have difficulty accessing traditional hospital-based outpatient services.
For example, significant mobility problems, requirements for continuous staff supervision or challenging behaviour may create seemingly insurmountable logistical challenges which can limit or preclude access to specialist epilepsy services.
Lack of input from a specialist team can hugely impact on a person’s quality of life due to suboptimal seizure control, an increased burden of seizure related injuries, an increased rate of emergency hospital admissions and unnecessary exposure to side-effects of anti-seizure medicines such as sedation or unsteadiness.
The main goals of the project were to improve seizure control, reduce the burden of seizure-related injuries and deaths, reduce the adverse side-effects from medication, cut hospital admissions and improve the involvement of clients, carers and families in the management of epilepsy.
The project also worked to reduce overall healthcare costs by reducing seizure related injuries, unnecessary prescriptions and avoidable hospital admissions.
The outreach service allows the same healthcare team members to keep in contact over much longer periods of time, working across traditional boundaries between hospital and community settings. Multiple individual cases of improved seizure control, effective anti-seizure drug rationalisation and avoided unnecessary hospital admissions have been observed.