Patient counseling across neurologic subspecialties-a single academic center study

Counseling is a routine part of neurologic care, but little is known about how commonly it is documented. We sought to characterize counseling in routine neurologic care by determining the proportion of visits with documented counseling, describe forms of counseling, and investigate factors that predict documentation of counseling.

We performed a cross-sectional study via retrospective chart reviews of 994 neurologic subspeciality outpatient encounters at a tertiary academic medical center from September 2023 to October 2023. The main outcome of this analysis was documented counseling (Yes/No) which was established via protocol-driven pre-specified chart review with assessment of abstraction reliability. Secondary outcomes included lifestyle modification (e.g., exercise, sleep, diet, alcohol, safety) and medication/disease specific education counseling (e.g., headache, seizure, medication, cognitive, stroke). We used a multivariable generalized estimating equations regression model with clustering at the provider level to compare how patient counseling varied across provider subspecialities.

Out of 994 outpatient encounters, 38% (n = 374) of visits had any documented counseling. Counseling on medication/disease specific education (28%, n = 276) was more common than on lifestyle education (6%, n = 60). The neurologic subspecialties with highest percentage of documented counseling were headache (73%), epilepsy (51%), and stroke (41%) while the neurologic subspecialties with the lowest percentage of any documented patient counseling were neuromuscular (19%), cognitive (15%), and multiple sclerosis (11%). Headache subspecialists were the only provider group to have increased odds of counseling (OR = 3.6, CI: 1.3-9.9) compared to general neurologists, while cognitive and multiple sclerosis subspecialists had 73% (CI: 42%-78%) and 72% (CI: 25%-89%) lower odds of documenting any counseling. Patient demographics were not statistically significantly associated with frequency of counseling.

Our study demonstrated significant variability in frequency and types of counseling documented across neurologic outpatient encounters and between subspecialists. The findings suggest that patient counseling may be undocumented and/or under-employed in certain fields. Future multi-centered studies are needed to understand documentation practices, actual performance of counseling relative to documentation, and patient clinical outcomes after participating in counseling.