Assessing the needs of pharmacists and physicians in caring for patients with epilepsy

Using design thinking to strengthen the community pharmacist's role in epilepsy care

OBJECTIVE

To use design thinking to develop a community pharmacist-led intervention for people living with epilepsy (PWE) with desirable, feasible, and viable features.

METHODS

This study used design thinking. Three patient personas were created based on previous research: a newly diagnosed PWE, a well-controlled PWE, and a complex PWE with uncontrolled seizures. An intervention prototype was developed for each of the three personas. Structured interviews were conducted with pharmacists, pharmacy students, patients with diagnosed epilepsy, and caregivers to elicit feedback on which features of each intervention prototype were desirable, feasible, and viable. Interviews were analyzed using rapid content analysis. A multidisciplinary advisory group and the research team prioritized features of the prototypes to include in the final intervention.

RESULTS

The following four features were identified as desirable, feasible, and viable for a pharmacist-led intervention for PWE: (1) pharmacist-patient consultations, (2) care plan development, (3) regular check-ins, and (4) care coordination with other health care providers.

SIGNIFICANCE

This study identified evidence-based features for a community pharmacist intervention to support epilepsy care using design thinking. A pilot study to evaluate this intervention on the quality of life (QoL), health outcomes and satisfaction of PWE can inform the implementation and feasibility of such patient services.

Factors influencing community pharmacists' knowledge about women's issues in epilepsy

Background

Previous studies have highlighted instances where pharmacists lacked knowledge regarding women's health issues related to epilepsy.

Objectives

To assess UAE community pharmacists' knowledge, toward women's issues in epilepsy.

Methods

a cross-sectional research method was employed. A team of seven pharmacy students in their final year visited a randomly selected sample of community pharmacies in the UAE and face-to-face interviews were conducted with the pharmacists using a structured questionnaire. The questionnaire includes two parts; Eight questions designed to elicit data about the demographics of the study participants and 12 questions eliciting insights into the participants' knowledge of women's issues in epilepsy.

Results

A total of 412 community pharmacist were recruited in the study. The overall level of knowledge about women's issues in epilepsy was good and the average knowledge score was 81% with a 95% confidence interval (CI) [79.1, 82.7%]. The results of multivariate analysis showed higher knowledge scores in chain pharmacies (OR 1.37; 95% CI 1.12-1.67), Chief pharmacists (OR 1.44; 95% CI 1.01-2.06), Pharmacists in charge (OR 3.46; 95% CI 2.7-4.45), pharmacists with 1-5 Years of experience (OR 2.87; 95% CI 1.71-4.82), pharmacists with 6-10 Years (OR 2.63; 95% CI 1.58-4.38), pharmacists with >10 years (OR 3.13; 95% CI 2.03-4.83), graduation form regional universities (OR 1.37; 95% CI 1.12-1.67), graduation form international universities (OR 1.73; 95% CI 1.36-2.20) and receiving a training on epilepsy (OR 1.36; 95% CI 1.12-1.67).

Conclusion

While the findings reveal an overall promising level of knowledge among community pharmacists regarding the issues faced by women with epilepsy, pinpointing which clinical and demographic factors have the most significant impact on this knowledge would permit the implementation of tailored educational interventions. Workshops and modules targeting the issues faced by women with epilepsy would further raise the knowledge and competence among community pharmacists in this area, ensuring better pharmaceutical care for this population.

Differences in knowledge about epilepsy and antiepileptic drugs among pharmacy-dispensing workers in Cambodia and in Lao PDR

Epilepsy is the most common neurological disorder encountered in primary care in Southeast Asia. People with epilepsy require long-term therapy management. Nonadherence to antiepileptic drugs (AEDs) has been identified as a major factor in suboptimal control of epilepsy. Pharmacies offer patients a first-line point of contact with the healthcare system. Many pharmacies operate with limited or nonqualified human resources that can lead to insufficient knowledge, inappropriate supply of medicines, and insufficient counseling.

OBJECTIVE

The aim of this study was to evaluate the qualification and knowledge concerning epilepsy and AEDs among pharmacy-dispensing workers who sell drugs to people with epilepsy.

METHOD

A cross-sectional qualitative study was conducted in public and private pharmacies, in both urban and rural areas of Cambodia and Lao People's Democratic Republic (Lao PDR). The knowledge was collected through a questionnaire.

RESULTS

A total of 180 respondents from 123 outlets in the two countries were included in this study. A proportion of 40.8% (31) of respondents in Cambodia and 38.5% (40) in Lao PDR were pharmacists, followed by sellers who did not received any healthcare training with a proportion of 18.4% (14) in Cambodia compared to 20.2% (21) in Lao PDR. Head trauma was cited as the main cause of epilepsy by 72.4% (55) in Cambodia and 27.2% (28) in Lao PDR (p < 0.001). Epilepsy was considered as a contagious disease by 6.6% (5) of respondents in Cambodia compared to 18.4% (19) in Lao PDR (p = 0.03). Eighty-seven percent (66) of respondents in Cambodia knew at least one long-term AED versus 67.3% (70) in Lao PDR (p = 0.003). Phenobarbital was mentioned in more than 90.0% of cases in both countries. In overall, 15.4% (21) thought that if seizures are controlled for some months, people with epilepsy could stop taking their AEDs. Only one respondent from Lao PDR was aware of drug-drug interaction between AEDs and oral contraception.

CONCLUSION

An educational intervention should be implemented to improve the knowledge of epilepsy and AEDs for pharmacy-dispensing workers. This could include advice for all pharmacy-dispensing workers in order to improve AED management and follow-up of therapeutic adherence.

Pharmacists' knowledge of issues in pharmacotherapy of epilepsy using antiepileptic drugs: A cross-sectional study in Palestinian pharmacy practice

OBJECTIVE

Antiepileptic drugs (AEDs) are mainstay in controlling epileptic seizures. As experts in medications, pharmacists should be able to ensure accuracy of dosing regimens, explain adverse effects, and screen for and alert people with epilepsy (PWE) and their physicians to possible drug-drug interactions (DDIs). The aim of this study was to evaluate pharmacists' knowledge of issues in pharmacotherapy of epilepsy using AEDs.

METHODS

This was a cross-sectional observational study conducted in the Palestinian pharmacy practice. A 10-item case-based questionnaire was used to determine actions taken by pharmacists in theoretical situations in pharmacotherapy of epilepsy. Demographic and practice details of the study participants were also collected. Scores were calculated as percentage of correct answers for each participant.

RESULTS

The number of participants was 394. The majority (approximately 75%) identified themselves as community pharmacists. The median score was 33.4% with an IQR of 33.3. Pharmacists who received training on epilepsy and AEDs during their pharmacy degree program were 4.78-fold (95% C.I. of 1.82-12.60) more likely to score ≥50% in the test than those who did not receive training on epilepsy and AEDs. Despite gaps in knowledge, pharmacists tended to perform the necessary action in cases of adverse effects and aggravated seizures associated with AEDs.

CONCLUSION

Pharmacists can play a crucial role in providing essential information on AEDs to patients and prescribers. There are many knowledge gaps that need to be filled. Specifically designed pedagogic and/or training interventions might be helpful in filling these gaps.

Evaluation of pharmacists' knowledge of women's issues in epilepsy: A cross-sectional study in Palestinian pharmacy practice

PURPOSE

Pharmacists are key players in providing healthcare for patients with chronic diseases including women with epilepsy. The purpose of this study was to assess pharmacist's knowledge of women's issues in epilepsy in the Palestinian pharmacy practice.

METHOD

The study was conducted in a cross-sectional observational design using a 12-item test on women's health in epilepsy. Demographic details were collected. Scores were calculated as percentage of correct answers for each pharmacist.

RESULTS

The sample consisted of 408 pharmacists. The median correct score was only 53.8% with an IQR of 30.8. Pharmacists who interacted with ≥10 patients with epilepsy per month were 1.61 (95% C.I of 1.04-2.49) more likely to score ≥60% in the test than those who interacted with <10 patients with epilepsy per month. The difficulty index ranged from very easy to difficult. Nearly 91% of the pharmacists answered correctly the question on the role of folic acid in reducing teratogenesis and only 46% answered correctly the question on exposure to valproic acid and the risk of giving birth to a child with autism.

CONCLUSION

Although pharmacists could be knowledgeable and in key position to provide essential information to patients with chronic diseases, there are many knowledge gaps in women's health issues in epilepsy that need bridging. Greater exposure to and interaction with people with epilepsy might be helpful in enhancing knowledge of pharmacists of specific issues pertaining to women's health in epilepsy.

Role of pharmacists in the management of patients with epilepsy

OBJECTIVES

The aim of this article is to highlight the roles that pharmacists currently have in the management of patients with epilepsy and the opportunities and challenges associated with these roles.

KEY FINDINGS

There are many opportunities for pharmacists in the management of patients with epilepsy owing to the accessibility and extensive knowledge of drug therapy. The role of pharmacists extends beyond dispensing medications. The pharmacists have a significant role in the education of patients about the disease and therapy, encouraging adherence and explaining side effects and providing information on potential drug-drug interactions, resulting in improved clinical outcomes and decreased costs. Physicians prefer pharmacists as information sources for medication profile and drug interaction screening for patients with epilepsy. However, there are certain challenges which the pharmacists should overcome if effective medication therapy management services are to be provided on a routine basis. Educational interventions are required to improve the knowledge and skills of pharmacists. The gap between patients' and pharmacists' views of the pharmacist's role has to be narrowed to ensure enhanced role of the pharmacists in this patient group.

CONCLUSIONS

There are a lot of opportunities and challenges for pharmacists to provide medication therapy management services for patients with epilepsy. Evidence in the literature provides justification for such services. However more research is required to provide foundation for routine provision of such services in all healthcare facilities.

An evaluation of pharmacists' knowledge of women's issues in epilepsy

OBJECTIVE

Although epilepsy affects men and women equally, there are many women's health issues in epilepsy. These issues challenge both the woman with epilepsy and the many health care professionals involved in her care. As antiepileptic drugs (AEDs) play a major role in the treatment of epilepsy, pharmacists can serve an important function in the health care of patients with this chronic disease. The goal of this educational project was to assess pharmacists' knowledge of women's issues in epilepsy using the Knowledge of Women's Issues and Epilepsy II (KOWIE-II) questionnaire.

METHODS

In this cross-sectional study we used the valid and reliable KOWIE-II questionnaire, a 10-item questionnaire on women's issues in general as well as pregnancy-related issues. A random sample of pharmacists registered in Ohio either were sent the KOWIE-II questionnaire or completed it prior to a live seminar. Demographic and practice-related data were collected. A percentage correct score was calculated per pharmacist.

RESULTS

Our sample consisted of 152 completed surveys. On the questionnaire, the overall average correct score was 60.3%. Nearly 75% of pharmacists had a correct score for the statement inquiring about the drug interaction between enzyme-inducing AEDs and contraceptives. Slightly less than 70% knew of the issue of AED-induced bone loss. Almost one-third (32.2%) of the respondents answered incorrectly when asked about the frequency of sexual dysfunction in women with epilepsy, though an even higher percentage chose "don't know." Most of the pharmacists (69.1%) stated "don't know" when asked about the relationship between hormones and seizure control. More than 70% correctly answered four of the six pregnancy-related statements (folic acid=77.0%, healthy babies=82.9%, continued AED adherence during pregnancy=86.8%, choice of AED during pregnancy=71.1%). Fewer pharmacists knew about vitamin K supplementation (57.9%), and even fewer answered the question on breastfeeding correctly (33.6%). Pharmacists who interacted with the most patients per month had the highest scores.

CONCLUSION

Pharmacists are in a key position to help women with epilepsy, and though there are some areas where pharmacists are generally knowledgeable about women's issues in epilepsy, there are still gaps in knowledge where educational interventions are clearly needed.

Patients with epilepsy's perception on community pharmacist's current and potential role in their care

A cross-sectional study was conducted surveying patients with epilepsy about the current and potential role community pharmacists play/could play in their care. Seventy-five patients (mean age=38.9 years, 66% female) were enrolled, either from the outpatient epilepsy clinic or from the local Epilepsy Foundation database. Patients were asked a series of questions about six aspects of their health care, as well as which of these aspects would be important to discuss with their pharmacist and what type of relationship they currently have/desire with their pharmacist. Results indicated that patients most commonly use their pharmacist for two aspects of their health care: drug interaction information (65%) and adverse effect information (56%). Fewer patients use their pharmacist for the four other aspects of their care: seizure frequency (13%), antiepileptic drug adherence (27%), medication profile (39%), and impact of their disease on their lifestyle (27%). Many patients want their pharmacist to be more involved in their health care, especially regarding drug interactions (76%), discussing adverse effects (74%), and maintaining a complete medication profile (61%). Patients also desired that their pharmacist communicate with their epileptologist about drug interactions (69%) and adverse effects (64%). Although many patients reported having a good relationship with their community pharmacist, a large concern was lack of privacy for holding conversations and lack of desire to pay for such pharmacy services if available. Overall, these results indicate that the majority of patients with epilepsy do not use their pharmacists to their full potential, yet certainly desire to do so, especially regarding drug interactions and adverse effects. Both pharmacists and patients should strive to form better partnerships that would allow them to take advantage of existing opportunities to enhance patient outcomes.

An assessment of patient and pharmacist knowledge of and attitudes toward reporting adverse drug events due to formulation switching in patients with epilepsy

A survey was developed to gather information from both patients with epilepsy and community pharmacists on the issue of antiepileptic drug (AED) formulation switching, which includes brand to generic, generic to brand, and generic to generic. Data were obtained from 82 patients (or parents of patients) with epilepsy and 112 community pharmacists. More than 92% of patients and 85% of pharmacists agreed that switching between forms of the same AEDs may cause an increase in seizures or adverse effects. More than two-thirds of our patient sample reported having problems with formulation switching; many also reported knowing other patients with problems. Just more than half (51%) of the pharmacists knew of patients who have described problems when they have changed AED formulations. Less than 50% of both populations knew that problems resulting from formulation switching should be reported as adverse drug events to the FDA. Not many pharmacists and far fewer patients use MedWatch to report these problems. We conclude that both patients with epilepsy and pharmacists are underinformed and underinvolved with reporting adverse drug events.

Prescribers' knowledge of and sources of information for potential drug-drug interactions: a postal survey of US prescribers

BACKGROUND

Given the high prevalence of medication use in the US, the risk of drug-drug interactions (DDIs) and potential for patient harm is of concern. Despite the rise in technologies to identify potential DDIs, the ability of physicians and other prescribers to recognize potential DDIs is essential to reduce their occurrence. The objectives of this study were to assess prescribers' ability to recognize potential clinically significant DDIs and to examine the sources of information they use to identify potential DDIs and prescribers' opinions on the usefulness of various DDI information sources.

METHODS

A postal questionnaire was developed to assess prescriber knowledge of medications that may interact and prescribers' usual sources of DDI information. Recipients were asked to classify 14 drug pairs as 'contraindicated', 'may be used together but with monitoring' or 'no interaction'. A response option of 'not sure' was also provided. The questionnaires were sent to a national sample of 12 500 prescribers based on past history of prescribing drugs associated with known potential for DDI, who were identified using data from a pharmacy benefit manager covering over 50 million individuals.

RESULTS

Usable questionnaires were obtained from 950 prescribers. The percentage of prescribers who correctly classified specific drug pairs ranged from 18.2% for warfarin and cimetidine to 81.2% for paracetamol (acetaminophen) with codeine and amoxicillin, with 42.7% of all combinations classified correctly. The number of drug pairs correctly classified by the prescribers ranged from 0 to 13. For half of the drug pairs over one-third of the respondents answered 'not sure'; among those drug pairs, two were contraindicated. When asked what source was used to learn more about a potential DDI, a quarter of the prescribers reported using personal digital assistants and another quarter used printed material. The majority of the prescribers (68.4%) reported that they were usually informed by pharmacists about their patients' potential exposure to DDIs. Compared with the prescribers who used other sources, those who used computerized DDI alerts as their usual source of DDI information consistently gave a lower rating score to the five statements that assessed the usefulness of the information.

CONCLUSION

This study suggests that prescribers' knowledge of potential clinically significant DDIs is generally poor. These findings are supported by other research and emphasize the need to develop systems that alert prescribers about potential interactions that are clinically relevant. Physicians most commonly reported learning about potential DDIs from pharmacists, suggesting further work is needed to improve the drug-prescribing process to identify potential safety issues earlier in the medication use process.

Use of focus groups as a tool to enhance a pharmaceutical care practice

OBJECTIVES

To demonstrate the utility of the focus group as a tool for pharmacists to use to determine the perceived drug-related needs of patients and prescribers and to use the information collected from focus groups to create a practice enhancement plan.

DESIGN

Focus groups consisting of patients, prescribers, and pharmacists were asked a series of questions exploring potential drug-related needs and their views regarding who should take responsibility for addressing these needs. The information was synthesized to reveal items of consistency and disparity among groups, and the findings were used to create a plan for a developing pharmaceutical care practice.

SETTING

Grocery store chain pharmacy in a suburban metropolitan area.

PATIENTS AND OTHER PARTICIPANTS

Pharmacy patients, nurse practitioners (NPs), physician assistants (PA)s, and pharmacists.

RESULTS

Data describing the process of focus group application in a community pharmacy setting and information relevant to enhancement of a specific practice were collected. Total time required to gather information was approximately 60 hours. Focus groups were held with NPs/ PAs and patients; pharmacists were interviewed. Patients' self-described drug-related needs included education, ensuring they receive the right medication, ensuring efficacy, interaction screening, and refills. Prescribers defined their needs as primarily administrative, specifically mentioning formulary management. Both patients and NPs/PAs saw pharmacists primarily as a source for medications and medication information and did not view them as significant contributors to comprehensive drug therapy management.

CONCLUSION

Focus groups are a useful method for gathering information for the purpose of practice development. Data gathered through this work identified a significant gap in awareness of both the qualifications and capabilities of pharmacists, suggesting that future success of the pharmaceutical care practice is dependent on altering existing perceptions held by patients and prescribers.

Frequency and trends of interventions of prescriptions in Flemish community pharmacies

OBJECTIVE

To study the role of the community pharmacist in medication management.

METHOD

Participating Flemish pharmacists quantified their interventions during two weeks by use of validated diagrams. The clinical interventions were recorded in detail, while the technical interventions were only registered.

RESULTS

124 pharmacists participated. Intervention was needed in 4.1% of the total number of prescriptions (n = 87.647). On average, 20.2 technical and 8.4 clinical interventions over a period of 2 weeks per pharmacy were needed. The main problem was missing or incorrect data on administering the drug (23%). Missing or incorrect advice (37.8%), dose-related problems (26.1%) and interactions or contra-indications (20.2%) were mentioned as important clinical discrepancies. The pharmacists utilized the patient medication records to solve most of the problems. In one out of five cases, the physician was contacted.

CONCLUSION

Interventions by community pharmacists in medication management have been recorded in this study. The results should be translated into a process of integrated pharmaceutical care.

Provision of Pharmacy Services in Community Health Centers and Migrant Health Centers

OBJECTIVES

To assess the frequency with which pharmacy services are provided in community health centers (CHCs) and migrant health centers (MHCs), the importance of these services in these settings, and pharmacists' preparedness to provide these services and to determine whether pharmacist- and site-specific characteristics are related to the provision of pharmacy services.

DESIGN

A self-administered mail survey was used to collect information on the provision of traditional pharmacy services and on the provision of pharmaceutical care services in four domains: collecting, organizing, and evaluating information; formulating a course of action; providing medications and counseling patients; and monitoring and managing patient outcomes. Data were also gathered on pharmacist- and site-specific characteristics. Descriptive and inferential statistics were calculated.

PARTICIPANTS AND SETTING

Surveys were mailed to a sample of 1,260 contact persons (medical/executive directors and pharmacists).

MAIN OUTCOME MEASURES

Pharmacist-reported frequency of the provision of pharmacy services, respondents' perceptions regarding the importance of the provision of pharmacy services, and respondents' perceived level of preparedness to provide pharmacy services.

RESULTS

Pharmacists in CHCs and MHCs provided traditional services very often, felt that the services were important, and felt very prepared to provide the services. Although frequency and perceived importance and preparedness varied across and within the four pharmaceutical care domains, pharmacists most often reported collecting, organizing, and evaluating information and providing medications and counseling patients. Least often reported was formulating a course of action, followed by monitoring and managing patient outcomes. Similarly, pharmacists felt least prepared to provide these services. Pharmacists who had received additional education and training reported that they provided pharmacy services significantly more often (P < .05) and felt significantly more prepared to provide the services.

CONCLUSION

Additional pharmacy-related education and training may be helpful in preparing pharmacists in CHCs and MHCs to increase their provision of pharmaceutical care services.