Burns Carly V, Lucas Kristen, Faraj Maggie, Millis Scott, Garwood Candice, Marawar Rohit
Department of Pharmacy, Harper University Hospital, Detroit Medical Center, Detroit, MI, USA.
Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.
Epilepsy Behav. 2023 Mar;140:109109. doi: 10.1016/j.yebeh.2023.109109. Epub 2023 Feb 11.
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.
在所有年龄组中，老年人癫痫的患病率最高。由于存在合并症、多种药物治疗以及认知障碍，该群体的护理工作较为复杂。我们旨在评估门诊药剂师对减少该群体住院次数的影响。
我们在一家三级医疗中心进行了一项病例对照研究。研究组在一个多学科的老年癫痫门诊就诊，有门诊药剂师提供服务，以协助进行药物核对、评估和依从性管理。对照门诊也为老年癫痫患者提供护理，但没有药剂师。在门诊就诊三个月后，比较住院次数及相关因素。使用描述性统计报告人口统计学数据。进行多项回归分析，以评估药剂师的存在及其他相关变量对预测住院次数的效果。
在19个月的时间里，研究组和对照组分别有58例和74例患者就诊。研究组和对照组门诊就诊分别有26.6%和18.4%与住院有关（无显著差异）。研究组认知障碍患者明显更多（53.4%对16.2%；p<0.001），根据查尔森合并症指数（CCI）衡量的合并症负担更高（平均3.5对2.9；p=0.02），与对照组相比，每月发作超过1次的患者数量更多（17.2%对6.8%）。与癫痫无关的住院与较高的CCI相关。与癫痫相关的住院与每月发作次数>1次有关（风险增加>3倍）。
本研究表明老年癫痫患者情况复杂，涉及多种因素。虽然有药剂师参与时的住院次数与对照组相似，但研究组的患者群体更为复杂。需要更多研究来评估药剂师在老年癫痫门诊护理中的最佳使用方式。
