Prescribing Antiepileptics for the Elderly
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THERAPY IN PRACTICE
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Prescribing Antiepileptics for the Elderly Differences between Guideline Recommendations and Clinical Practice Mary Jo V. Pugh,1,2 Perry J. Foreman3,4 and Dan R. Berlowitz5,6 1 2 3 4 5 6
South Texas Veterans Healthcare System, San Antonio, Texas, USA Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA Michael E. DeBakey VA Medical Center, Houston, Texas, USA Department of Neurology, Baylor College of Medicine, Houston, Texas, USA Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Affairs (ENRM VA) Medical Center, Bedford, Massachusetts, USA Boston University School of Public Health, Boston, Massachusetts, USA
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 861 1. Recommendations for Antiepileptic Drug Treatment in Older Patients Newly Diagnosed with Epilepsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 863 1.1 Clinical Practice Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 864 1.2 Professional and Health Policy Organisations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 865 1.3 Expert Consensus Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 865 2. Are Recommendations Translated into Practice? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866 2.1 Nursing Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866 2.2 Community-Dwelling Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 867 3. Diffusion of Innovations Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 867 4. Factors Associated with Slow Translation of Research into Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . 869 4.1 Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 869 4.2 Dissemination of New Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 869 4.3 Availability of Opinion Leaders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 871 4.4 Evidence Supporting ‘Superiority’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 871 4.5 No
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