Improving Folic Acid Supplementation Rates in Women of Childbearing Age with Epilepsy

Publication date: Available online 14 December 2017
Source:Pediatric Neurology
Author(s): Puja Patel, Jules C. Beal, Shlomo Shinnar
AimTo improve the rate of folic acid supplementation to adolescent women with epilepsy (WWE) on an anti-epileptic drug regimen (AED) seen by the pediatric neurology providers at the Children's Hospital at Montefiore (CHAM), in compliance with the 2009 American Academy of Neurology and American Epilepsy Society practice parameter.MethodsWe designed a quality improvement study with implementation of a series of interventions and compared folic acid supplementation rates pre- and post-intervention. We made additional comparisons based on specific age groups (12-15 years and 16-21 years) and a diagnosis with or without developmental impairment.ResultsA review of 1,850 charts from 2004-2015 showed an average folic acid prescription rate of 41%. Supplementation rates gradually increased to 52.2%, 58.5%, 60.3%, and finally up to 81.6% after these respective intervention: Initial email reminder, provider education, posting signs in exam rooms, and implementation of an electronic medical record best practice advisory. There was improvement across all categories, in both age groups (12-15 years and 16-21 years) and in those with or without developmental impairment. There was a trend to higher compliance rates in adolescents without developmental impairment.ConclusionsOur interventions resulted in an increase in folic acid supplementation rates of adolescent women with epilepsy. These results are encouraging. We plan to extend education about the recommendations for folic acid supplementation to non-neurology providers, as well as expand to apply our interventions and assess adherence to other defined epilepsy quality measures.



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