Anticonvulsant Medication Polypharmacy Review: A descriptive study of value-based care practices in the management of seizure disorders in a pediatric special needs population

1Cadiz E, 2Northrup M, 2Jose A, 2Wilken P
1LECOM Bradenton, Weston, FL, USA; 2The Center For Discovery, Monticello, NY, USA

As health care costs, clinical inefficiency, and duplication of services rise, society is burdened with the task of finding an emerging solution to decrease cost. Value-based health care departs from the traditional fee-for-service approach and focuses on an evidence-based, cost-effective way to improve health for those with chronic conditions by suggesting reimbursement for outcomes received rather than for volume of services delivered. Value is described as the number of good clinical outcomes per cost spent to deliver those outcomes. Cost includes the actual resources involved in the patient's care process (i.e. time, resources, support). Value encompasses the appropriateness of care and use of resources for a specific disease. As a NY State designated Center for Excellence, The Center for Discovery is researching potential metrics to consider for a Value-Based Payment Model in services for people with special needs. This process requires determining the tools needed to treat a specific medical condition, the proper outcome measures, and the measurement of these outcomes. As part of this investigation, we determined the prevalence of polypharmacy treatment regimens at the Center for Discovery for pediatric residents with diagnosed seizure disorders. We endeavored to define value-based care pertaining to seizure disorder management in our population. To determine how to implement optimal value-based care, we investigated the role of polypharmacy in seizure disorder management and the metrics involved. Polypharmacy is the use of 2 or more same-class medications to treat a single diagnosis. The anticonvulsants prescribed do have significant side effect profiles; therefore, our goal is to identify the necessity of polypharmacy in this population with seizure disorders, optimize care for patients to create valuable outcomes, and in effect lower the cost and burden on healthcare. We analyzed a set of 176 pediatric patients with special needs at the Center for Discovery and aligned their diagnoses with medication treatment regimens through thorough chart review and categorized groups of diagnoses and neurology resources needed (i.e. medications prescribed, clinic visits, etc.). We found that 54% (n=95) of patients reviewed were prescribed anticonvulsants. Of those 95 patients, 70% were actively taking anticonvulsants for management of a diagnosed seizure disorder. We found that 13.7% (n=10) of patients are on anticonvulsant polypharmacy regimens. We found a similar distribution of seizure types and average number of visits to neurology provider in patients on polypharmacy regimen compared to those prescribed monotherapy for management of specific seizure diagnoses. Future directions would include determining high-risk criteria for polypharmacy patients with seizure disorder and exploring a broader patient population and comorbid medical conditions.

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