P2B216: Bridging the Treatment Gap in Epilepsy: A Cross-sectional Study of Pakistani Physicians’ Perceptions of Barriers to Care and Self-reported Competency

Background: Of the 50 million patients with epilepsy, 23 million live in Asia. Amongst Asian countries, Pakistan faces an epilepsy treatment gap of 88%, with only one neurologist per 1 million population. At every level, from diagnostics to treatment, physicians who see patients with epilepsy face a lack of support. This paper examines local physicians’ perceptions of epilepsy care in Pakistan. Measuring these perceived barriers is the first step in improving the delivery of care for patients with epilepsy.

Methods: This cross-sectional study was conducted among healthcare providers in Pakistan. To account for the variability in barriers identified across urban and rural areas in Pakistan, the study surveyed healthcare providers across four provinces of Pakistan. The survey included four thematic categories: perceptions about epilepsy, patients’ access to epilepsy care, providers’ perceptions of clinical barriers, and physician competency. The study questionnaire, consisting of twenty Likert-scale questions and a demographic information section, was validated by local experts for cultural and content relevance and electronically distributed to a network of medical providers. Factor analysis was conducted for data distillation.

Results: Of the 87 responses that were gathered, 52 were fit for analysis. The majority of respondents specialized in a field related to pediatrics, with 14 individuals (26.9%) specializing in pediatric neurology and 15 respondents (28.8%) specializing in pediatrics. Results (Table 1) show little to no endorsement of myths surrounding seizures and epilepsy. 69.2% of physicians agreed that epilepsy poses interpersonal difficulties. Regarding providers’ perceptions of clinical barriers, 17.3% reported insufficient access to diagnostic modalities to screen for epilepsy. 11.5% expressed uncertainty in having a complete understanding of the medical reasoning for prescribing an antiepileptic drug. Similarly, 17.3% of respondents disagreed or felt impartial towards fully comprehending the contraindications and managing antiepileptic drug side effects.

Conclusion: This study illustrates the limited access physicians have to diagnostic modalities and the need for more training to adequately manage the complex nature of epilepsy and its biopsychosocial manifestations. We hope the study findings will serve as crucial formative steps to identifying and understanding barriers to epilepsy care and improving the diagnosis and treatment of epilepsy in Pakistan. We suggest that more efforts be made to support Pakistani physicians through funding, education, and awareness of the treatment gap. To better address the community’s needs with increased cultural sensitivity, future studies will collect survey responses from the general public, then compare them with the current survey results.