Access to Neurology Healthcare Professionals in the United States Among Patients With Epilepsy Using Medicaid: A Retrospective, Observational, Claims-Based Analysis

INTRODUCTION: This retrospective, longitudinal, observational study of claims data assessed provider access barriers among patients (aged ≥ 18 years) with epilepsy enrolled in Medicaid in the United States. METHODS: Records of patients with ≥ 1 epilepsy diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes: 345.4/345.40/345.41/345.5/345.50/345.51/345.7/345.70/345.71; ICD-10-CM codes: G40.0/G40.1/G40.2/G40.5) or ≥ 2 diagnoses for unspecified convulsions (ICD-9-CM: 780.39; ICD-10-CM: R56.9) on different days (≤ 12 months apart) in STATinMED's RWD Insights all-payer claims database (1/1/2014-6/30/2021) were identified. Patients using Medicaid with ≥ 1 antiseizure medication (ASM) prescription (date of first ASM prescription = index date) on/after initial diagnosis and continuous capture of medical and pharmacy benefits for 12 months before the index date (baseline) and 12 months after and including the index date (follow-up) were included. Proximity to and use of neurology healthcare professionals (HCPs; neurology HCP = neurologist or neuropsychiatrist) for epilepsy-related care during the 12-month follow-up were assessed. RESULTS: The study included 24,722 patients (mean age: 43.3 years, female: 62.4%). Index ASM was prescribed mostly by HCPs who typically provide primary care (family practice/internal medicine physicians/nurse practitioners/physician assistants; 42.2%). During follow-up, > 85% of patients were using any second-generation ASMs, while 71.3% of patients had no access to an epilepsy-treating neurology HCP in proximity to their home. Access to an epilepsy-treating neurology HCP in proximity to home was more common among patients who resided in urban areas [30.3% (n = 6817/22,519)] than patients living in rural areas [12.6% (n = 278/2203)]. CONCLUSIONS: Most patients with epilepsy using Medicaid, particularly those living in rural areas, did not have access to neurology HCPs in proximity to their home, suggesting challenges to receiving optimal care. Graphical abstract available for this article.