An exploratory study of primary care pharmacist-led epilepsy consultations

Most epilepsies are managed with anti-epileptic drugs (AEDs), but medication non-adherence has been frequently reported. Satisfying patient information needs has demonstrated improved adherence. Multi-professional working has been encouraged to provide cost-effective health services by using the most appropriate healthcare professional. Research has demonstrated that pharmacist-led consultations are acceptable to patients with other medical conditions and therefore may be appropriate for patients with epilepsy. We aimed to determine the feasibility and acceptability of a pharmacist-led epilepsy consultation (PLEC) study. This encompassed estimating the eligibility and consent rate for a PLEC study, plus the acceptability of potential intervention outcome measures and likely effects.

Eligible patients with a diagnosis of epilepsy and prescribed AEDs were invited by telephone to attend a PLEC. Baseline adherence, general mental well-being, epilepsy-related quality of life and satisfaction with information received about epilepsy medication were recorded. The intervention was a 30 min consultation to provide participants with an opportunity to ask questions related to their epilepsy therapy. Baseline data collection was repeated after 2 months.

Of 106 (97.2%) consenting patients, 82 (77.4%) attended the PLEC. The 2 month follow-up questionnaire was fully completed by 50 (67.6%) participants. The number (percentage ± 95% confidence interval) of participants reporting adherent behaviour pre-PLEC was 22 (44.0 ± 13.7%) which increased to 30 (60 ± 13.6%) post-PLEC (P < 0.03, McNemar test).

Accepting the limitations of a before-and-after study and small sample size, the findings suggest that a PLEC may improve adherence. A definitive trial is necessary to confirm the effect of a PLEC and establish the longevity and cost-effectiveness of the outcomes. Attrition of potential participants not contactable by telephone suggests the need for additional postal contact in subsequent trials. A reduction in loss to follow-up is also desirable and potentially achievable using telephone reminders.