Impact of ambulatory pharmacist on hospital visits in older adults with epilepsy: A case-control study

Older adults have the highest prevalence of epilepsy of any age group. Care in this group is complex because of comorbidities, polypharmacy, and cognitive impairment. We aimed to assess the impact of an ambulatory pharmacist in decreasing hospital visits in this group.

We performed a case-control study at a tertiary care center. The study group was seen in a multi-disciplinary older adult epilepsy clinic with the services of an ambulatory pharmacist to help with medication reconciliation, assessment, and adherence. The control clinic also cared for older adults with epilepsy but lacked a pharmacist. The occurrence and factors related to hospital visits were compared three months post-clinic visit. Demographic data were reported using descriptive statistics. A multinomial regression analysis was conducted to assess how well hospital visits could be predicted by pharmacist presence and other relevant variables.

Over 19 months, 58 and 74 patients were seen in the study and control groups, respectively. 26.6% and 18.4% of study and control group clinic visits were associated with a hospital visit, respectively (nonsignificant difference). The study group had significantly more patients with cognitive impairment (53.4% vs. 16.2%; p < 0.001), a higher burden of comorbidities as measured by Charlson comorbidity index (CCI) (mean 3.5 vs. 2.9; p = 0.02), and a greater number of patients with >1 seizure per month (17.2% vs. 6.8%) as compared to the control group. Hospital visits unrelated to epilepsy were associated with a higher CCI. Hospital visits related to epilepsy were associated with >1/month seizure frequency (>3 times risk).

This study demonstrates the multifactorial complexity of older adults with epilepsy. While the presence of a pharmacist resulted in similar hospital visits as the control group, the study group had a much more complex patient population. More studies are required to assess the best use of a pharmacist in older adults with epilepsy outpatient care.