Abstract
Objectives To investigate the consequences of failure to attend (FTA) or delayed attendance at first seizure clinics (FSCs).
Methods Retrospective cohort study of patients referred to two FSCs in Melbourne between January 2008–December 2017. Patients‘ records were linked to state-wide hospital administrative databases up to June 2018.
We applied regression models to identify clinicodemographic factors associated with FTA, and to assess whether FTA, and/or time between FSC referral and attendance, influenced subsequent hospital utilisation.
Results 1458 eligible patients were referred to the study FSCs. 840 (58%) attended with a median 44 days (interquartile-range [IQR]: 18–91) between referral and attendance. 324 (22%) cancelled/rescheduled, and 294 (20%) failed to attend without notice.
Increased risk of FTA was associated with younger age (adjusted relative risk [aRR]=2.48; 95% confidence interval [CI]:1.70–3.63, p=0.001) and greater relative socioeconomic advantage (aRR=1.47; 95% CI:1.08–2.01, p=0.02).
FTA was associated with increased subsequent all-cause hospital admission (adjusted incidence rate ratio [aIRR]=2.69; 95% CI:2.06–3.50, p<0.001), all-cause ED attendance (aIRR=2.66; 95% CI:2.05–3.44, p<0.001), and seizure-related presentations (aIRR=2.34; 95% CI:1.63–3.37, p<0.001).
Delayed FSC attendance was similarly associated with increased subsequent all-cause hospital admission (aIRR=1.05 per month of delay; 95% CI:1.03–1.06, p<0.001), all-cause ED attendance (aIRR=1.07; 95% CI:1.05–1.08, p<0.001), and seizure-related presentations (aIRR=1.03; 95% CI:1.03–1.04, p<0.001).
Conclusion FSCs are an effective healthcare intervention for improving outcomes, as FTA and delayed attendance are associated with significantly increased subsequent hospital utilisation. Understanding barriers to timely FSC access is an important future direction for first seizure care.
