Disparities in epilepsy care: The role of provider decision-making

While there is extensive data describing disparities in the care of epilepsy patients, few studies have investigated their underlying mechanism. We evaluated the role of provider decision making in the management of seizures to determine if decisions varied across racial populations.

We evaluated clinic visits at the Penn Epilepsy Center between 2008 and 2023. We included visits with recent seizures, defined as any seizure since the previous visit or in the past year, whichever was more recent. We assessed three management decisions at each visit: increasing the patient's anti-seizure medication dose, adding a new anti-seizure medication, or referring the patient to the epilepsy monitoring unit (EMU). We used multivariable logistic regression models controlling for epilepsy severity and socioeconomic factors to determine if providers made different management decisions following a seizure depending on the patient's race.

Our study included 2715 patients and 17,255 clinic visits. At visits with recent seizures, there was no significant difference across racial populations in the odds of an antiseizure medication dose increase or addition. However, patients who identified as Black were more likely to be referred to the EMU after a seizure than White patients (OR 1.34 95% CI 1.11-1.62). Black patients were significantly more likely to be referred for differential diagnosis, while White patients were significantly more likely to be referred for presurgical evaluation (p < 0.004).

Providers were significantly more likely to refer Black patients with recent seizures to the EMU for differential diagnosis compared to White patients, irrespective of epilepsy severity or socioeconomic status, supporting race-associated differences in provider decisions. This did not affect medication management.