Spotlight on Advanced Practice Providers: A Critical Part of Epilepsy Care

We are shining a spotlight on the Epilepsy Foundation’s efforts to provide education about epilepsy care to advanced practice providers (physician assistants and nurse practitioners) in Alaska. Reaching these rural communities is critical. Alaska does not have any accredited epilepsy centers. With the closest center being thousands of miles away in Seattle, Washington, many Alaskans with epilepsy rely on primary care providers for their care.

Challenges in Hard to Reach Communities

People in rural or underserved communities with limited access to specialty care face many questions:

• What do I do if my seizure medications don’t work or my side effects are too hard on me?
• I am struggling with my mood. What help can I get?
• Where can I go for emergency care?
• Do I even have access to the latest treatments because of where I live?

These are questions all people with epilepsy can face, but they are a challenge in particular for large rural or underserved areas like Alaska. According to the Centers for Disease Control and Prevention, 7,300 people live with active epilepsy in Alaska. Active epilepsy means that a person is taking seizure medicine, has been diagnosed by a doctor with epilepsy, and/or has had at least one seizure in the past year.

While some of these people will do well on seizure medicine, for at least 1 out of 3 people with epilepsy, seizure medicines don’t work. These are the people who should be seen at an epilepsy center to explore other treatments.

What if there is no epilepsy center nearby?

There is no easy solution. One critical way to help is to ensure that health care providers in these regions who do care for people with epilepsy are up to date on evidence-based epilepsy care. It’s important they also understand the importance of referring to specialty care when necessary.

Providing Education to Physician Assistants

Advanced practice providers are on the frontline of health care. They are often the first health professionals people with epilepsy interact with. As part of the National Epilepsy Education and Awareness Collaborative, the Epilepsy Foundation partners with the American Academy of Physician Assistants (AAPA) to educate physician assistants (PAs) about epilepsy. The partnership also helps link PAs to local Epilepsy Foundations, self-management resources, and epilepsy centers.

In October 2019, Epilepsy Foundation staff provided education about critical aspects of epilepsy care at  the Alaska Academy of Physician Assistants meeting.

At this meeting, the Foundation was able to share evidence-based guidelines and best practices on a few areas, such as:

• Recognizing and treating breakthrough seizures, cluster seizures, and seizure emergencies.
• Challenges of identifying comorbidities (associated health problems) that can mimic epilepsy or lead to a wrong diagnosis.
• Emotional health challenges that affect treatment and quality of life for people with epilepsy.
• Resources for managing epilepsy and referring to specialized epilepsy care.

Discussions with the PAs brought up the following questions:

• Should providers in areas without epilepsy centers refer people with epilepsy earlier than providers in resource rich areas? Obtaining a consultation sooner may help primary care providers manage seizures or potential emergencies with newer therapies more easily. Earlier consultations could help improve diagnosis and care of people with epilepsy and mood problems.
• How can PAs access epilepsy centers more quickly?
• Could telementoring epilepsy programs help in remote areas?
• Are different strategies needed to help treat depression in people of different cultural and social groups?

Working together to help answer and find solutions for these questions can help improve epilepsy care in rural populations in the future.

Frontline Providers for Epilepsy

Primary care providers, such as physician assistants, will remain key frontline providers caring for people with epilepsy in rural and underserved communities. Equipping PAs with tools for managing epilepsy can contribute to improved outcomes for people living with epilepsy.

Meeting the epilepsy continuing educational needs of providers through a variety of platforms is critical. Telementoring (Project ECHO^®), webinars, and online education address some barriers providers encounter in rural areas.

AAPA and the Epilepsy Foundation work collaboratively to seek opportunity for providers practicing in rural states, such as in Alaska, to have the most current management and treatment information. This helps them provide the best care for their patients living with epilepsy.