Abstract：
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.
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.
摘要：
目的：在任何年龄组中，老年人的癫痫患病率最高。由于合并症，该组的护理很复杂，多药，和认知障碍。我们旨在评估门诊药剂师在该组中减少住院次数的影响。
方法：我们在三级护理中心进行了病例对照研究。该研究组在一家多学科的老年癫痫诊所就诊，由一名门诊药剂师提供服务，以帮助进行药物和解，评估，和坚持。对照诊所还照顾患有癫痫的老年人，但缺乏药剂师。临床访视后3个月比较与住院相关的发生情况和因素。使用描述性统计报告人口统计学数据。进行了多项回归分析，以评估如何通过药剂师的存在和其他相关变量来预测医院就诊。
结果：超过19个月，在研究组和对照组中观察到58例和74例患者，分别。26.6％和18.4％的研究组和对照组的临床访问与医院访问相关，分别(无显著差异)。研究组的认知障碍患者明显增多(53.4%vs.16.2%；p<0.001)，查尔森合并症指数(CCI)衡量的合并症负担较高(平均3.5vs.2.9；p=0.02），更多的患者每月癫痫发作>1次（17.2%vs.6.8%）与对照组相比。与癫痫无关的医院就诊与较高的CCI相关。与癫痫相关的医院就诊与>1/月的癫痫发作频率(>3倍的风险)相关。
结论：这项研究证明了老年人癫痫患者的多因素复杂性。虽然药剂师的存在导致与对照组相似的医院就诊，研究组的患者群体要复杂得多.需要更多的研究来评估老年人癫痫门诊护理中药剂师的最佳使用。
方法：我们在三级护理中心进行了病例对照研究。
结果：超过19个月，
结论：这项研究证明了老年人癫痫患者的多因素复杂性。
