Outcomes of Pharmacist Interventions for Management Antiepileptics Drug Using in Patient with Epilepsy at Setthathirat Hospital in LAO PDR.

Abstract

The objective of this study was to establish and develop a multidisciplinary team for epilepsy management at an outpatient clinic at the department of neurology, Setthathirath hospital, LAOS PDR. The study was a mixed-method research including qualitative interviews and quasi-experimental study. The duration of study was carried out between November 2021 to August 2022. Descriptive statistics constitute numbers, percentages, mean, and standards including gender, age, education, occupation, marital status, the residence of the patient, monthly income of patients, family history of epilepsy, seizure frequency, number of AEDs, type of epilepsy, type of AEDs, comorbidities, seizure type, medication history. Descriptive statistics constitute numbers, percentages, mean, and standards including gender, age, education, occupation, marital status, the residence of the patient, monthly income of patients, family history of epilepsy, seizure frequency, number of AEDs, type of epilepsy, type of AEDs, comorbidities, seizure type, medication history. Wilcoxon Signed Rank Test was implemented for statistical analysis. Measuring clinical outcomes as efficacy outcomes were: patients' adherence, patients' knowledge, seizure frequency, Drug-related problems drug (interaction, adverse action, over dosage), and quality of life. Qualitative interviews were Individual and focus group interviews. The face-to-face interviews were based on 6 healthcare professionals: 2 doctors, 2 nurses, and 2 pharmacists. The major themes that emerged from the interviews consisted of healthcare professionals’ experiences of current practice problems with antiepileptic drug therapy, and healthcare professionals’ perspectives on ways to improve services. The focus group interview interviewed 6 healthcare professionals including 2 doctors, 2 nurses, and 2 pharmacists. The major themes were the collaborations among healthcare professionals and the expectations of pharmacists’ roles. The results from the qualitative interviews were used to develop the intervention of a quasi-experimental study, called “multidisciplinary team for management antiepileptic therapy”. The study compared 68 patients before and after the intervention. There were 24 males and 44 females.

The patients were aged 18-39 years old. The patients have education at the level of secondary 30.9%. Most of them are single 54.4%. Followed by high school and university level (29.4%). Most patients lived in out-town 72.1%. The main occupation of the patient was selling the product 36.8%, followed by a career Government officer 17.6%. The comorbidities of the patient were hypertension at 7.4% with depression at 2.9%. The most favored regimen was monotherapy 95.6%. The mean percentage of pill count in month 3 (90.17 ± 4.55) was statistically significantly higher than the first visit 0 (58.15 ± 27.31), (p <0.0001). The mean percentage of pill count in month 3 (90.17 ± 4.55) was statistically significantly higher than the first visit 0 (58.15 ± 27.31), (p <0.0001). The mean score of the antiepileptic drug knowledge for patients in the pre-test and the post-test in visit (month 0) were 6.00 ± .45 and 9.58 ± 1.12 (p-value = 0.000). The outcome showed a statistical difference after receiving an intervention. The most frequent DRPs were drug interactions 10 (14.7%), Failure to receive drugs 9 (13.2%), weight gain 4 (5.9%), alopecia 2 (2.9%), headache 2 (2.9%), over dosage 2 (2.9%), allergy 1 (1.5 %), behavior change 1 (1.5%). After the provision of a multidisciplinary team managed, The DRPS decreased respectively. Most patients had frequencies seizure more than 3 times/month 20 patients. After the provision of a multidisciplinary team, the frequency of seizures decreased 3 times/month in (month 3) 7 patients and visit month 6, respectively. There were statistically significant differences (p <0.01). There were significant differences (p<0.05) in these 7 domain functions: mood, work limitations, social limitations, memory problems, physical treatment effects, cognitive treatment effects, and seizure worries. But in 3 domain functions: energy, mobility, and general QOL There were no statistically significant differences (p ≥0.05). There were significant differences (p<0.01) in overall scores of QOLIE-10 between the 6 months before and after the 6 months of the provision of a multidisciplinary team.

Conclusion: A multidisciplinary team can manage patients with epilepsy by improving medication adherence, patients' knowledge, seizure frequency, Drug-related problems, and quality of life in patients with epilepsy in Laos. As part of the healthcare team, pharmacists need to engage at every stage to monitor the patient’s response and determine the most effective treatment.

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