Geographic use and performance of distributed home video-electroencephalography in Australia

Objective

To determine the geographic use of a distributed Australian home video-electroencephalography (video-EEG) service and whether diagnostic yield or technical performance varied with remoteness, clinic distance, or area-level socioeconomic disadvantage.

Methods

We retrospectively analysed 3,502 home video-EEG studies from 3,457 patients recorded at 24 clinic locations between September 2022 and March 2024. Patient postcodes were linked to the Modified Monash Model (MMM) and the Index of Relative Socio-economic Disadvantage (IRSD). Straight-line distance to the assigned clinic was compared with distance to the nearest public comprehensive epilepsy centre. Modified Poisson and linear models examined event, diagnostic, video, and final-check impedance outcomes.

Results

Studies originated from 1,112 postcodes; 854 (24.4%) were regional/rural and 17 (0.5%) remote/very remote. For regional/rural studies, the assigned clinic was a median 59.3 km closer (interquartile range [IQR]: 1.2 km farther to 116.6 km closer) than the public-centre comparator and was closer in 68.0% of studies. Median referral-to-recording time was 33.9 days in regional/rural studies and 25.5 days in metropolitan studies. At least one reported or discovered event occurred in 54.7% of studies. Adjusted analyses showed no evidence that remoteness was associated with poorer event ascertainment, seizure or interictal findings, video observability, or final-check impedance. No clinic-distance or socioeconomic association remained significant after multiplicity correction.

Significance

Distributed home video-EEG brought the point of connection closer to many regional/rural recipients without evidence of lower diagnostic yield or poorer technical performance among service recipients. Regional/rural referral-to-recording intervals were longer, and remote/very remote representation was sparse, so comparable access gains in genuinely remote populations remain uncertain.

Key Points

• A national home video-electroencephalography service was used across 1,112 postcodes; 24.4% of studies were regional/rural.

• For regional/rural studies, assigned clinics were 59.3 km closer (interquartile range: 1.2 km farther to 116.6 km closer).

• Remoteness and clinic distance were not associated with lower diagnostic yield or poorer technical performance.

• Regional/rural referral-to-recording time was 8.4 days longer than in metropolitan studies.

• Remote/very remote data were sparse, so comparable access gains in genuinely remote populations remain uncertain.