An audit of people with epilepsy, aged 16–55 years, taking valproate in UK primary care in 2023–4

Abstract

Purpose

To audit the standard of clinical care of people with epilepsy (PWE), aged 16–55 years, taking valproate attending UK general practice.

Method

The case notes of 213 PWE (44 women, 169 men) were audited against standards based on National Institute for Health and Care Excellence (NICE), Drug Safety Unit (DSU) and Medicines and Healthcare products Regulatory Agency (MHRA) guidelines.

Results

For PWE taking valproate annual review rates in General Practice (GP) were consistently sub-standard, with an average of 42 % for women and 31 % of men in the last 5 years. Fifty percent of men had seen no clinician in 2023 concerning their epilepsy, compared with 23 % women (p = 0.0013). Generalised onset epilepsy was diagnosed in 75 % women and 63 % men. A range of medication was used as add on therapy, with lamotrigine, levetiracetam, and clobazam being most often used. Sixty eight percent of women were actively engaged with the valproate pregnancy prevention program (Valproate PPP); a further 21 % had clear clinical reasons where potential pregnancy was not an issue (history of hysterectomy, severe learning disability) whilst the remaining 11 % of those who should have been engaged with the Valproate PPP were not. Four men had received pre-conceptual counselling. Exposure to valproate for more than 10 years was present in 80 % women and 73 % men. Fifty percent of women and 42 % men were receiving vitamin D supplementation. Eighteen (8 %) people had a bone density scan, 39 % of which were abnormal.

Conclusion

The standard of care of PWE taking valproate in primary care is concerning, with poor yearly review rates, especially for men. Engagement with the Valproate PPP was absent in 11 % of women, who should have been engaged with this. Long exposure and the lack of vitamin D supplementation needs attention. The re-introduction of the Quality and Outcomes Framework (QOF) for epilepsy with defined clinical targets could potentially address the needs identified.