Improving Folic Acid Supplementation for Women of Childbearing Age With Epilepsy

Birth complications such as autism and neurodevelopmental disabilities have an increased incidence in women with epilepsy (WWE), associated with the use of antiseizure medications, which can be mitigated with folic acid supplementation. This quality improvement (QI) project aimed to increase folic acid prescription rates from 18% to 50% for WWE between ages 18 and 47 seen at a level 4 epilepsy center.

Data from the electronic health record (EHR) were obtained for women meeting inclusion criteria and were analyzed using descriptive statistics and QI methods. Four Plan-Do-Study-Act cycles were conducted during the intervention phase including provider education, implementation of an EHR screening tool, introducing patient educational flyers into clinic rooms, and reporting provider data to improve awareness of prescribing barriers.

Baseline data were collected from January through June 2022, identifying 1,032 patients meeting inclusion criteria. Interventions began in July 2022 and concluded in March 2023 during which time 1,252 patients met inclusion criteria. Folic acid prescription rates for WWE of childbearing age were increased from a baseline of 17.37% to 35.03%. Folic acid prescribing increased throughout the intervention phases. Improving provider awareness of their own prescribing habits along with educational interventions had the largest impact on increasing prescribing rates. All providers effectively received the initial educational intervention.

This QI study demonstrated that increasing provider education and awareness of current clinical practice guidelines increases folic acid prescribing rates for WWE of childbearing age without negatively affecting clinical workflow. This highlights the importance of provider education and ongoing monitoring of folic acid prescribing rates to improve patient outcomes and identifies a series of interventions that can be replicated in a variety of clinical settings.