Quality Improvement Opportunities in Caring for Patients with Nonepileptic Seizures

Table 1

Patient, provider, and system factors contributing to care for patients with nonepileptic seizures and characteristics triggering psychiatric or psychological referral.

Factors	Less suited towards referral	More suited towards referral
Patient and family factors	Belief in stigmatization of psychiatric care and that it may not be helpful	Acceptance that psychiatric referral can be helpful and is not stigmatizing
	Belief in external locus of control of symptoms	Belief in internal locus of control of symptoms
	Fair to good insight and awareness of psychosocial stressors	Poor to fair insight and awareness of psychosocial stressors
	More emotionally supportive and more physically present family and or friends	Less emotionally supportive and less physically present family and or friends
Provider factors
Neurologist (referring  physician) factors	Comfortable and/or has sufficient time and energy to manage psychiatric comorbidities	Less comfortable and has insufficient time to manage psychiatric comorbidities
Psychiatrist (receiving  physician) factors	Not as interested in care of patients with neurological disorders or not believing that psychiatric/psychological interventions may be helpful	Comfortable with and has predilection to manage affectively challenging patients
System factors	Lack of availability of psychiatrists and psychologists locally	Availability of psychiatrists and psychologists as well as opportunities to build “shared appointments” with neurologists
	Inability of neurologists and psychiatrists to dedicate sufficient time to care coordination for patients with NES	Ability of neurologists and psychiatrists to communicate effectively and have regular meetings and or open channels of communication regarding care coordination for patients with NES