Abstracts

Rationale: Anti-epileptic drug (AED) response is an important component of patient history. Detailed AED histories are time-consuming and often not systematically collected and/or documented. We have developed a clinical practice model utilizing clinical pharmacists to systematically collect and record detailed AED response phenotypes in an AED response database (ARD) within the computerized patient record system (CPRS) of the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS). Methods: Patients with epilepsy are initially referred to the West Los Angeles VA Seizure Disorder Clinic. Prior to the patient’s first clinic visit, clinical pharmacists trained in epilepsy management perform a comprehensive review of medical and prescription information available through CPRS and remote access of other VA Medical Centers or Department of Defense sites. After the review, the clinical pharmacist contacts the patient by telephone to perform a thorough AED use interview. AED response histories are then documented in CPRS utilizing a systematically devised template. The template consists of two sections addressing current and past AED use and assesses: current and past seizure control, perceived patient efficacy for each individual AED rated on a scale of 0-100%, perceived patient efficacy for each AED regimen ranked in order of best to worst, adherence based on prescription refill history rated on a scale of 0-100%, duration of treatment, highest dosage achieved during treatment, reason for discontinuation, adverse effects, drug levels, drug-drug and drug-disease interactions, and relevant laboratories and other studies. During the clinic visit, this ARD is available in CPRS for the clinician’s use. The clinician may verify the information with the patient and may utilize the ARD to aid in guiding clinical decision-making. After the clinic visit, the patient is seen by the clinical pharmacist who reviews and counsels the patient on medication changes and updates the database. Results: The ARD was initiated in July 2008. To date, there have been over 260 patient encounters and over 140 individual patient AED histories collected. Use of the ARD also facilitates clinician-patient, pharmacist-patient, and clinician-pharmacist interactions. Conclusions: The ARD provides a complete and thorough AED history for clinicians in the epilepsy clinic. Use of the ARD allows for optimization of patient care by providing accurate AED history, shortening the length of time clinicians must spend on clarifying past AED use, improving quality of care, and enhancing patient safety. Our clinical practice model utilizing a specially trained clinical pharmacist in an epilepsy/seizure disorder clinic and use of a systematically devised template for AED histories ensures accurate assessment of drug utilization and response and greatly enhances patient care.