Italian Hospital Pharmacists Have Key Roles in Ensuring Access to Medications and Care for Patients with Epilepsy

The hospital pharmacists’ role in treating patients with epilepsy starts with their place on the multidisciplinary team, which identifies appropriate drug selection in the hospital. It continues with counseling and therapy reconciliation to assure smooth transitions upon patient discharge to the community.

A recent online article in Global & Regional Health Technology Assessment reviewed how hospital pharmacists in Italy could positively affect drug therapy outcomes for patients with epilepsy.¹

Because of the country’s national health system, obtaining prescription drugs in Italy differs from region to region.The various geographic areas determine drug formularies and purchasing capabilities, and establish regional prescribing centers under the auspices of the different agencies of the Italian Medicines Agency.

Concept of brain diseases, mental health, Alzheimer's, Parkinson's disease, dementia, stroke, and seizure. Nootropics use to improve memory and neural

Epilepsy medications around a brain | image credit: MohamadFaizal | stock.adobe.com

Hospital pharmacists direct many of the tasks related to therapeutic benefits, procurement, reimbursement, and price.Furthermore, hospital pharmacists in Italy hold key positions on national and local ethics committees where they are involved in clinical trials and evaluate patients’ drug adherence behaviors. Additionally, hospital pharmacists review aspects of epilepsy therapy, evaluate adverse events, and determine various drugs’ risk/benefit profiles for entire population’s benefit via the National Pharmacovigilance Network.

The hospital pharmacists’ role in treating patients with epilepsy starts with their place on the multidisciplinary team, which identifies appropriate drug selection in the hospital.It continues with counseling and therapy reconciliation to assure smooth transitions upon patient discharge to the community.

A new approach to ensure patient adherence and successful therapeutic outcomes centers on the home delivery of some medications. The National Health System pharmacists interact with the patients via a software application, which also allows for monitoring of adverse events and clinical follow-up by the care team members.When the region identifies a direct delivery method for anti-epileptic drugs (AEDs), local community pharmacists dispense these medications and provide specialized counseling.

Along with other healthcare professionals on the interdisciplinary team, hospital and clinical pharmacists are instrumental in selecting the proper drugs for patients with epilepsy. They monitor and evaluate the medications prescribed for appropriateness and clinical effects and offer counseling and education to help achieve positive drug therapy outcomes and enhance quality of life.

Deprescribing also offers a crucial role for these pharmacists.² Even if patients with epilepsy might have a better quality of life when an AED is withdrawn, the risk of loss of control of symptoms and relapse exists. This issue poses a great concern to deprescribing a drug for these patients.¹

When considering stopping an AED, prescribers need to be mindful of the patient’s adherence pattern and personal preferences. Some patient concerns might include complications that could occur from drug cessation, namely reactivation of seizure activity, and other social consequences.

About the Author

Sandra J. Grillo, MBA, RPh, is a retired independent community pharmacist with more than 40 years of experience. She is currently a student in the University of Connecticut Medical Writing program.

Input from other health care professionals can help gauge the appropriateness of deprescribing AEDs in these patients. Since there is no current literature available that assesses the impact of this process in patients with epilepsy, it represents an area where more research is needed.

Epilepsy’s burden on healthcare systems, society, and the general public is great.Drug selection, clinical monitoring, timely delivery, and deprescribing are all ways that hospital pharmacists can be integral participants in the healthcare team. Working collaboratively, they can develop and implement new ways to deliver AEDs, help in disease management, and enhance the quality of life in these patients.

REFERENCES

1. Pani M. The role of the hospital pharmacist to guarantee access and continuity of care for the management of epilepsy. Glob Reg Health Technol Assess. 2024;11(Suppl 1):8-10. doi:10.33393/grhta.2024.2970

2. Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging deﬁnition of 'deprescribing' with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80(6):1254-1268. doi:10.1111/bcp.12732