Pharmacist-managed telephone clinic review of antidementia medication effectiveness

To describe the development and implementation of a telephone clinic for evaluating continued effectiveness of antidementia medication therapy in patients with dementia.

Ambulatory care at the Veterans Affairs Salt Lake City Health Care System.

A pharmacist-directed, telephone dementia clinic review of patients taking dual antidementia therapy to determine whether a medication-discontinuation trial is appropriate based on caregiver global impressions.

Pharmacists review eligible patients' electronic medical records for adherence history and caregiver impressions of response to antidementia medications to determine if a discontinuation trial of antidementia medication is warranted. Pharmacists coordinate any discontinuation discussion with caregivers and medical providers and monitor patients' response to the resultant interventions via telephone.

Pharmacist involvement allows for a structured method of monitoring adherence with antidementia medications and for determining whether they continue to provide benefit.

Expected results include percentage of patients who underwent a medication-discontinuation trial, percentage of patients who did not demonstrate clinical decline after a discontinuation trial, and percentage of patients who subsequently restarted medication because of noticeable decline after the discontinuation trial.

This telephone clinic capitalizes on the expertise of clinical pharmacists and helps establish a functional collaboration between health care providers, patients, and the electronic medical record to obtain a multiperspective evaluation of the effectiveness of antidementia therapy from a patient-centric view. This systematic approach improves patient-centered care and may have favorable impacts on antidementia medication cost utilization.