Demonstration project on epilepsy in Brazil: situation assessment
Demonstration project on epilepsy in Brazil: situation assessment
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DOI：
10.1590/s0004-282x2007001000002
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发表时间：
2007-06-01
影响因子：
1.4
通讯作者：
Sander, Josemir W.
中科院分区：
文献类型：
--
作者：
Li, Li M.;Fernandes, Paula T.;Sander, Josemir W.
目的：在初级卫生保健的背景下为癫痫患者提供服务情况评估，作为巴西癫痫示范项目的一部分，该项目是WHO/ILAE/IBE全球运动“走出阴影”的一部分。方法：我们在三个地区进行了挨家挨户的流行病学调查，以评估癫痫的患病率及其治疗缺口。我们对来自巴西不同地区的598名初级卫生保健工作者进行了抽样调查，以评估他们对初级保健环境中癫痫患者管理的看法。结果：癫痫的终生患病率为9.2/1000人[95%CI 8.4~10.0]，活动性癫痫患病率估计为5.4/1000人。38%的活动性癫痫患者没有得到足够的治疗，其中19%的患者没有服用药物。这项对卫生工作者的调查显示，他们估计，在他们护理的患者中，60%的患者没有癫痫发作。他们估计，55%的患者接受单一治疗，59%的患者被转介给神经科医生。估计在工作或学习的患者的平均百分比为56%。大多数医生(73%)对管理癫痫患者没有信心。讨论：示范项目地区的流行病学调查表明，癫痫的患病率与其他资源贫乏的国家相似，治疗差距很大。造成治疗差距的一个因素是卫生保健提供不足。巴西的情况很容易得到改善，因为初级保健系统具备管理癫痫所需的关键要素。为使这项工作切实有效，需要：i)建立一个转介网络；ii)持续提供抗癫痫药物；iii)通过通报系统(Sistema de lnformacao da Atencao Basica-SIAB)密切监测癫痫的治疗；以及iv)对卫生专业人员进行持续教育。教育项目应该是广泛的，不仅包括医疗管理，还包括癫痫的心理社会方面。
Purpose: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. Methods: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from different regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. Results: The lifetime prevalence of epilepsy was 9.2/1,000 people [95% Cl 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19% who were taking no medication. The survey of health workers showed that they estimated that 60% of patients under their care were seizure-free. They estimated that 55% of patients were on monotherapy and that 59% had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56%. Most of the physicians (73%) did not feel confident in managing people with epilepsy. Discussion: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements required for epilepsy management. To make this effective and efficient requires: i) an established referral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de lnformacao da Atencao Basica - SIAB) and iv) continuous education of health professionals. The educational program should be broad spectrum and include not only medical management, but also psycho-social aspects of epilepsy.