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3.2.1 Protocol for identifying patients

Relevant Tools:A.16, A.18

This protocol outlines the steps that need to be taken to maintain a practice register, including the relevant Read codes. (See A.16 and A.18)

Identify patients with a diagnosis of epilepsy

Identify all patients with a diagnosis of epilepsy who have taken AEDs. Your computer software will help you do this.

All major suppliers have onscreen prompts to let the user know when a patient is in a disease category that qualifies for QOF points.

All major suppliers also have preset report libraries to quickly identify patients in any QOF category. You may well have done much work in the last year or two, to find all (or nearly all) of your patients with epilepsy. However, you may have missed some, which may be identified in step two.

Ensure that all those identified as patients with epilepsy on AEDs are marked in their computer records with the Read code ‘F25’ (see A.18). Make sure that the correct start date is used when you enter a code – it should be the date that the diagnosis was made.

Your software may be able to pick out and report patients that may have epilepsy but who do not have a valid Read code in the notes. If you are unsure how to run these reports you can ask your CCG or CSU for help.

Practices should validate their registers periodically – annually – if possible.

Identify epilepsy patients without a Read code diagnosis

Some patients may actually have epilepsy, but the diagnosis has not yet been registered on your computer with a recognisable Read code. Some of these may be new diagnoses which have escaped being entered on the practice computer. Others may have been diagnosed many years ago, but the diagnosis is only in old paper notes and has never been entered on the computer. You can find most of these by searching for patients taking AEDs.

Once a year, preferably early in the annual QOF cycle, ask your computer for a report on all patients who have received AEDs in the last year who do not have a diagnosis of epilepsy. Your computer supplier’s software probably has a preset report function, so you can do this fairly easily. The software may even have a report to pick out patients that the software thinks may have epilepsy, but who do not have a valid Read code in the notes. If you do not have the skills in your practice to run these reports, ask your PCT IT department for help.

For those practices that cannot use a computer to perform this task, a manual search can be done by reviewing all repeat prescriptions for AEDs over a three month period, then checking the notes to see if these patients have epilepsy. Conditions other than epilepsy for which AEDs are prescribed may include neuropathic pain, bipolar disorder, essential tremor, infantile spasms, migraine, cardiac arrhythmia, trigeminal neuralgia and mood stabilisation.

Identifying epilepsy patients not taking AEDs

Some patients will have epilepsy, but do not have a Read code for AEDs. They will not count towards QOF points, but still have a clinical need for an annual review. A few may receive drugs directly from hospital or in clinical trials and so the AEDs they use are not on the practice computer. Others may have decided not to take AEDs, or have dropped out of follow-up. A few may be on non-pharmacological treatment. Many will be patients whose seizures have ceased. Run an annual report of patients with a diagnosis of epilepsy that are not on an AED. Again, your computer supplier probably has a preset report function to help you with this.

Most of these patients who have a diagnosis of epilepsy but who are not taking AEDs will benefit from an annual review.

Tips for finding a diagnosis of epilepsy:

The software provided by computer suppliers helps to find patients who should be on the epilepsy register but aren’t. Using this software is the most efficient method of identifying these people, but the following tips may also help.

Be aware that the diagnosis may be:

  • in a consultant’s letter
  • in a discharge summary
  • in an A&E attendance report
  • in a record of consultation.

The diagnosis may appear in records preceding the first issue of an AED. Remember, drugs may have been issued from a hospital pharmacy and not appear on the GP records for some time after diagnosis.

Patient identification search

When conducting a computer search of patients taking AED medication, all of the following will be included if a report is created using the Read codes: dn% and d26%.

GenericBrand
AcetazolamideDiamox®
CarbamazepineTegretol®
ClobazamFrisium™
Clonazepam Rivotril®
Eslicarbazepine acetateZebinix®
EthosuximideZarontin®
GabapentinNeurontin®
LacosamideVimpat®
LamotrigineLamictal®
LevetiracetamKeppra®
OxcarbazepineTrileptal®
Phenobarbitone/phenobarbital-
PhenytoinEpanutin®
PregabalinLyrica®
PrimidoneMysoline®
RetigabineTrobalt®
RufinamideInovelon®
Sodium valproateEpilim®
TiagabineGabatril®
TopiramateTopamax®
VigabatrinSabril®
Valproic acidConvulex®
ZonisamideZonegran®

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