The Advantages of Multidisciplinary Care and APP Incorporation in Epilepsy

Lucretia Long, APRN-CNP

Across the breadth of neurology, multi- and interdisciplinary care teams have become a hot topic of discussion as more institutions adopt this model of care for their patients. Among individuals with epilepsy, the need for this type of care is clear and apparent, with a variety of benefits regarding patient outcomes.

At the 2022 American Epilepsy Society Annual Meeting, held December 2 to 6, in Nashville, Tennessee, a professional development session was held highlighting the career pathways for nonphysician medical professionals in the epilepsy care paradigm. Lucretia Long, APRN-CNP, an associate clinical professor of neurology at OSU Wexner Medical Center, was among those presenting and offered her perspective on the role of the nurse practitioner in epilepsy care.¹

She spoke with NeurologyLive® at the meeting about the current layout of the interdisciplinary care team at her institution, and the advantages that brings to care. Specifically, she highlighted the role that the pharmacy department at OSU Wexner Medical Center plays, assisting with providing patient history and medication counseling for those individuals who have comorbidities or are on multiple therapies

NeurologyLive^®: What advantages does the multidisciplinary approach bring specifically to epilepsy?

Lucretia Long, APRN-CNP: We talk a lot about the importance of interdisciplinary clinics. So, for example, we have a nonepileptic event clinic, and that encompasses not just the physician and the advanced practice provider, but also a clinical psychologist. Equally important, I think, is the role of clinical pharmacists in the role of epilepsy. We have been able to incorporate a collaboration with our pharmacy department, and so they're able to not only assist with providing the history for patients and families with epilepsy, but also to provide an opportunity to counsel patients on medications, for example, and maybe to think outside of the box, in terms of looking at other comorbid conditions and concomitant medications to help us move forward in terms of improving outcomes for patients and families with epilepsy.

When it comes to the institutions where these care teams exist, what are the challenges in terms of bringing those teams together?

I think finances can be the biggest challenge, ensuring that we have appropriate funds for all of those interdisciplinary team members. Another challenge, I think, is ensuring that we're able to get everyone in the same clinic at the same time. Everyone's so busy with different roles and responsibilities, that I think the timing and the ability to incorporate everyone in that same setting can be one of the other barriers, even in a center that has a lot of resources.

Do those challenges then have a downstream effect on care?

Oh, I think it has a dramatic improvement in overall outcomes for patients and families with epilepsy. I think we can look at minimizing ER visits and quality parameters, like patient satisfaction. As you know, patients with epilepsy have a lot of challenges with transportation. So, if you can incorporate a single visit with that multidisciplinary team where everyone's there providing appropriate and comprehensive care, you can provide a more efficient process and minimize traveling expenses, and also reduce the need for patients to take time off work, for example. It's a much more efficient process.

How do you think that the APC/APP community could be better utilized in the current paradigm of clinical care?

I think what you guys are doing is amazing and really increasing the awareness for other advanced practice providers and physicians on the importance of a multidisciplinary team. That is really important. Avenues like the American Epilepsy Society, and what we're doing here today can kind of expand the knowledge and exposure to the significance of these interdisciplinary teams and, hopefully, increase the involvement across the country for these types of interdisciplinary clinics. That, I think, will in turn improve funding that's available to promote this type of process for our patients, which then brings more members to the team.

Are there any trends based on the current clinical practice of these teams that you’ve noticed?

The trends are embracing genetics, for example, as an interdisciplinary process. The nonepileptic event clinics have been ongoing for quite some time, but I think they are getting more exposure. Pregnancy clinics are huge. In the field of epilepsy, we have an amazing clinic where we have not just our clinical pharmacist involved, but also our OBGYN colleagues who are specialized in the field of epilepsy. Those are areas where not just the advanced practice providers, but, again, the interdisciplinary team can kind of come together and move forward to advance outcomes.

Pregnancy in epilepsy care and the inclusion of OBGYNs has been a major theme in research in recent years, is that a trend that you see continuing?

Absolutely. I think it's crucial. We have a lot of wonderful OBGYN physicians across the country. But the opportunity to sort of collaborate with them on a patient with epilepsy can be very important in terms of overall outcomes. Making sure that we are acting on some of the novel information in terms of folic acid administration—things that we find simple, but in some cases, are complicated. Not everyone is implementing those health promotion interventions for female patients who are undergoing conception and interested in childbearing.

Is there anything else you think is important for the community to be aware of?

Just getting the word out. For me, it's crucial. I'm very proactive in the advanced practice provider world, and so really getting people to understand the importance that we have as APPs in the field of research and education as we move forward with these interdisciplinary teams is a goal. I think we have a lot to offer in terms of improving access for patients and families with epilepsy.

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REFERENCE
1. Long L. Career Pathways: Interprofessional Panel: Academic Appointment and Research. Presented at: AES Annual Meeting; December 2-6, 2022; Nashville, TN, and virtual. Professional development.