Care Gaps Found In Reproductive And Mental Health Support

What was studied

This study looked at reproductive-age youth with epilepsy who were seen in pediatric neurology clinics at one epilepsy program in Edmonton, Canada. It included 518 patients ages 10 to 18 who were referred to the University of Alberta Pediatric Comprehensive Epilepsy Program during the study periods from 2015 to 2019 and 2021 to 2022.

The researchers reviewed past medical records. They checked whether clinic charts documented reproductive health counseling, including contraception counseling and folic acid supplementation advice. They also looked at how often mental health comorbidities were documented in clinic charts and compared that with mental health diagnoses recorded in the health system database using ICD-10 codes.

What they found

Documentation of reproductive health counseling was uncommon. Contraception counseling was recorded for 17.0% of patients, and folic acid supplementation was recorded for 16.8%.

For mental health, clinical chart documentation and the health system database identified a similar overall share of patients with documented mental health comorbidities, 55% and 56.4%, respectively. However, the database listed a wider range of diagnoses, suggesting clinic charts may not fully capture the range of mental health comorbidities.

Limits of the evidence

This was a retrospective study, so it depended on what was written in existing records. If counseling happened but was not documented, the study would not capture it. It was also done at a single center, so the results may not reflect other clinics or health systems.

The study shows gaps in documentation and recorded counseling, but it cannot determine why those gaps happened or whether patients received counseling outside the neurology clinic. The abstract also does not give details about seizure types, medicines, or other factors that might affect counseling needs.

For families and caregivers

This study suggests that important topics for youth with epilepsy, like contraception, folic acid, and mental health, may not be discussed often or may not be clearly recorded in some epilepsy clinics. It also suggests that mental health concerns may be documented more completely in health system databases than in clinic charts.

For families, this may be a reminder that it is reasonable to ask the care team whether reproductive health and mental health have been reviewed, especially during the teen years. The study does not show what happens in every clinic, but it points to areas where care may be improved.

What to watch next

Future studies could look across multiple centers and track whether counseling happens, how well it is documented, and how mental health concerns are identified in different records.

Terms in this summary

retrospective study

A study that looks back at existing medical records rather than following patients forward in time.

reproductive health counseling

Discussions about reproductive health topics, such as contraception and folic acid supplementation.

folic acid

A B vitamin that may be discussed as part of reproductive health counseling.

mental health comorbidities

Mental health conditions that occur along with another medical condition, in this case epilepsy.

ICD-10 codes

Standard diagnosis codes used in health records and databases to label medical conditions.

ambulatory neurology clinic

A neurology clinic where patients come for visits without staying overnight in the hospital.