Regular Primary Care Decreases the Likelihood of Mortality in Older People With Epilepsy

OBJECTIVES: To investigate the effect of regular general practitioner (GPs) visits, separately from the frequency of visits, on the likelihood of all-cause death and epilepsy-related hospitalization in older Western Australian (WA) patients (>or=65 years) with diagnosed epilepsy. METHODS: We used routinely collected, whole-population linked, administrative medical data to ascertain the study population, the exposure, and outcomes. We identified 3537 patients aged >or=65 years who had been hospitalized at least once for epilepsy diagnosis in WA between 1992 and 2006. Pattern of GP visits was determined in the first 3 years of observation, followed by up to 11.5 years of follow-up for outcome ascertainment. A GP visit regularity index was calculated and quartiles of GP consultation regularity derived. Cox proportional hazards models, adjusted for multiple confounders, including GP visit frequency, were used to achieve the study aim. RESULTS: Patients in the least regular GP visit quartile had the worst all-cause survival with the difference in survival curves between GP visit regularity quartiles being significant (P = 0.0005). Compared with patients in the least regular quartile, patients in the second least regular (HR = 0.62, 95% CI = 0.41-0.93), second most regular (HR = 0.37, 95% CI = 0.22-0.62), and most regular (HR = 0.42, 95% CI = 0.23-0.78) quartiles had a significantly decreased likelihood of all-cause death. GP visit regularity did not appear to affect the likelihood of a second hospitalization for epilepsy. CONCLUSIONS: Higher regularity between GP visits, as distinct from higher GP visit frequency, reduces the likelihood of subsequent mortality in patients with the seize disorder.