Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational 'Collaborate' project

Adam J Noble, Amy Mathieson, Leone Ridsdale, E A Holmes, Myfanwy Morgan, Alison McKinlay, Jon Mark Dickson, Mike Jackson, Dyfrig A Hughes, Steve Goodacre, Anthony G Marson, Adam J Noble, Amy Mathieson, Leone Ridsdale, E A Holmes, Myfanwy Morgan, Alison McKinlay, Jon Mark Dickson, Mike Jackson, Dyfrig A Hughes, Steve Goodacre, Anthony G Marson

Abstract

Introduction: Emergency department (ED) visits for epilepsy are common, costly, often clinically unnecessary and typically lead to little benefit for epilepsy management. An 'Alternative Care Pathway' (ACP) for epilepsy, which diverts people with epilepsy (PWE) away from ED when '999' is called and leads to care elsewhere, might generate savings and facilitate improved ambulatory care. It is unknown though what features it should incorporate to make it acceptable to persons from this particularly vulnerable target population. It also needs to be National Health Service (NHS) feasible. This project seeks to identify the optimal ACP configuration.

Methods and analysis: Mixed-methods project comprising three-linked stages. In Stage 1, NHS bodies will be surveyed on ACPs they are considering and semi-structured interviews with PWE and their carers will explore attributes of care important to them and their concerns and expectations regarding ACPs. In Stage 2, Discrete Choice Experiments (DCE) will be completed with PWE and carers to identify the relative importance placed on different care attributes under common seizure scenarios and the trade-offs people are willing to make. The uptake of different ACP configurations will be estimated. In Stage 3, two Knowledge Exchange workshops using a nominal group technique will be run. NHS managers, health professionals, commissioners and patient and carer representatives will discuss DCE results and form a consensus on which ACP configuration best meets users' needs and is NHS feasible.

Ethics and dissemination: Ethical approval: NRES Committee (19/WM/0012) and King's College London ethics Committee (LRS-18/19-10353). Primary output will be identification of optimal ACP configuration which should be prioritised for implementation and evaluation. A pro-active dissemination strategy will make those considering developing or supporting an epilepsy ACP aware of the project and opportunities to take part in it. It will also ensure they are informed of its findings.

Project registration number: Researchregistry4723.

Keywords: accident & emergency medicine; epilepsy; health economics; organisation of health services; qualitative research.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Research project process diagram. ACP/s, alternative care pathway/s; DCEs, Discrete Choice Experiments; EDS, Emergency Departments; GP, General Practitioner; HRA, health research authority; NHS, National Health Service; PICs, Participant Identification Centres; PWE, People with Epilepsy.

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