Implementation of an older adult epilepsy clinic utilizing pharmacist services

Antiseizure medications are commonly associated with adverse effects including behavioral and cognitive issues, drug interactions, idiosyncratic reactions, and long-term complications, which can lead to non-adherence. At the same time, there are limited reports describing multidisciplinary models of epilepsy care that include pharmacists.

To describe the pharmacist services in an epilepsy clinic for older adults and document the patient care delivered using this design.

A subspecialty older adult epilepsy clinic, embedded within a neurology clinic, in an urban academic medical center.

Integration of pharmacy services to document medication history, provide medication reconciliation, identify medication-related problems, and make interventions.

Data were retrospectively evaluated for the patients seen by the pharmacist and epilepsy team between July 2019 and January 2021. Data were summarized with descriptive statistics.

Fifty-eight patients with a total of 94 encounters (70.7% of all specialty clinic visits) were seen collaboratively by the physician and the pharmacist. The majority of patients were African American (87.9%), aged 63.7 ± 8.2 years, and more frequently male (58.6%), and a high proportion had some baseline memory loss or diagnosis of dementia (53.4%). Medication reconciliation occurred in 94 (100%) encounters. More than half the encounters required reconciliation to the existing medication list by adding medication (55.3 % of encounters) or deleting mediations (53.2% of encounters). Presence of adverse effects was the most common medication-related problem identified (23.4%). Resolutions to the medication-related problems were also reported.

The population of older adults with epilepsy is expected to increase in prevalence. Pharmacists are able to impact medication-related problems in a vulnerable, high-risk patient population. The multidisciplinary model we describe here can be used as a template to provide care in ambulatory care practices involving other neurology specialties with a high proportion of older adult patients.