Examining Seizure Documentation Practices by Primary Care Clinicians

Background: Primary care clinicians (PCCs) frequently report low levels of comfort in managing seizure disorders, despite their essential role in caring for patients with seizures from systematically excluded groups. This study explores seizure care practices among PCCs at a federally qualified health center and examines possible associations between provider documentation of seizure care and proxy indicators for control of seizure disorder. Methods: This is a retrospective observational cohort study of patients presenting with a seizure disorder between 2015 and 2019. Logistic regression models examined the associations between patient demographics, clinical processes and outcomes, and electronic medical record documentation. Results: PCCs adhered to quality metrics for documentation in 41.5% of the 446 cases. PCCs documented seizure type 94.3% of the time but only recorded seizure frequency or time since last seizure 44.3% of the time. Most patients (52.3%) were referred to a neurologist. Better clinical documentation was significantly associated with referral to a neurologist (OR 1.73; 95%CI 1.14, 2.6; P = .009), visiting a neurologist (OR 1.7; 95%CI 1.13, 2.56; P = .01), and receiving a depression, anxiety, or quality of life screening (OR 2.97; 95%CI 1.84, 4.79; P < .001). Discussion: Our findings suggest the need for improvements in the documentation of seizure management in the primary care setting. PCCs may benefit from additional training or tools to improve their comfort with seizure treatment and understanding of the role of primary care for these disorders.