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Multidisciplinary Care May Help to Reduce Disparities Associated With Race in Youth With Psychogenic Nonepileptic Seizures - 11/01/24

Doi : 10.1016/j.pediatrneurol.2023.11.007 
Maggie Mary Burch, MSW, LISW-S a, Samantha Rossiter, MSW, LSW b, Katie McGinty-Kolbe, RN, MSN, FNP-C a, Megan Fredwall, MD a, Christy Tschirner a, Laurie Enciso, RN, BSN a, Jeannette Iskander, PhD c, Kristen Trott, PhD d, Kenneth Jackson, MS e, f, Dara V.F. Albert, DO, MEd a, ⁎
a Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio 
b Huckleberry House, Counseling Program, Columbus, Ohio 
c Akron Children's Hospital, NeuroDevelopmental Science Center at Akron Children's Hospital, Akron, Ohio 
d Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio 
e Department of Biomedical Informatics, College of Medicine, Center for Biostatistics, The Ohio State University, Columbus, Ohio 
f Nationwide Children's Hospital, Biostatistics Resource at Nationwide Children's Hospital (BRANCH), Columbus, Ohio 

∗Communications should be addressed to: Dr. Albert; Division of Neurology; Department of Pediatrics; Nationwide Children's Hospital; The Ohio State University; 700 Children's Drive; Columbus, OH 43205.Division of NeurologyDepartment of PediatricsNationwide Children's HospitalThe Ohio State University700 Children's DriveColumbusOH43205

Abstract

Background

Psychogenic nonepileptic seizures (PNES) are a common type of functional neurological disorder in which patients experience seizurelike episodes. Health disparities based on race and socioeconomics, documented in children with epilepsy and adults with PNES, have not been reported in children and adolescents with PNES. We hypothesize that disparities exist in this population, which impact overall care and therefore influence outcomes.

Methods

We retrospectively analyzed youth referred to our multidisciplinary clinic from 2018 to 2020. All patient charts were screened by social work before the visit to identify potential barriers to care, and a nurse conducted follow-up calls. Patients' race was identified from the electronic health record and compared with several variables. Outcomes were collected via phone follow-up. Descriptive statistics were produced, and comparisons between white patients and patients of other races were completed using Fisher exact tests and multivariable logistic regressions.

Results

During the study period, 237 patients were eligible for the analysis. Sixty-eight patients (29%) identified as a race other than white. Only 60%, 56%, and 40% of the cohort were reached for follow-up at one, three, and 12 months, respectively. In general, outcomes were similar between racial groups; however, we found that patients of nonwhite race were more likely to receive support from social work due to barriers identified in screening (P = 0.045).

Conclusions

Health disparities based on race may exist in youth with PNES. A multidisciplinary clinic including social work may help mitigate barriers leading to more equitable care and similar outcomes for white and nonwhite youth with PNES.

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Keywords : Health equity, Social determinants of health, Psychogenic nonepileptic seizures, Social work


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