Pharmacist impact on adherence of valproic acid therapy in pediatric patients with epilepsy using active education techniques

Ma, Mubai; Peng, Qilin; Gu, Xurui; Hu, Yani; Sun, Shusen; Sheng, Yanghao; Wang, Ping; Ma, Hongying; Zhou, Boting

doi:10.1016/j.yebeh.2019.06.003

Cited by 15 publications

(29 citation statements)

References 36 publications

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“…During every subsequent visit, our pharmacists recorded detailed information based on the pharmacist-patient encounters. We also provided pharmacy service to the patients, details of which are described in our previous study ( Ma et al, 2019 ). Follow-up surveys were conducted untill October 2019 using a form to record the patient-reported outcomes (PROs).…”

Section: Methodsmentioning

confidence: 99%

“…Generally, after the clinicians prescribed the first AED, we followed up the patients’ responses by PROs and regular therapeutic drug monitoring (TDM) to determine if the dosage needed adjustment to meet the AED therapeutic window. The bioassay conditions have been described in our previous study ( Ma et al, 2019 ). If unexpected severve AEs occurred at a low dosage or if the seizure control failed, an alternative AED was used ( Perucca et al, 2011 ).…”

Section: Methodsmentioning

confidence: 99%

“…Since the study aimed to analyze factors affecting the efficacy of AEDs, we excluded the records of patients who 1) exhibited poor medication adherence as determined by a simplified medication adherence questionnaire (SMAQ) with detailed criteria used to assess the adherence being described in our previous study (Ma et al, 2019), 2) received non-drug therapies such as surgery, electrical stimulation or ketogenic diet (Ricart, 2011), 3) were treated with a combination of AEDs other than those reported in Table 1, or other agents such as herbal medicine (Samuels et al, 2008), 4) had unevaluable information on AED efficacy, such as undetermined seizure frequency/nonepileptic seizures, or incomplete seizure diaries, 5) were in the phase of AED reduction/switching, and 6) had seizures as a result of alcohol or stimulating external factors.…”

Section: Patientsmentioning

confidence: 99%

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Evaluation of Factors Impacting the Efficacy of Single or Combination Therapies of Valproic Acid, Carbamazepine, and Oxcarbazepine: A Longitudinal Observation Study

Peng

et al. 2021

Front. Pharmacol.

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Objective: This study aimed to determine the efficacy and clinical factors related to the pharmacodynamics of single or combination therapies of valproic acid (VPA), carbamazepine (CBZ), and oxcarbazepine (OXC), three commonly used anti-epileptic drugs (AEDs) in China.Methods: The study evaluated the records of 2027 outpatients in a Changsha hospital, located in China, from December 23, 2015 to October 28, 2019. The baseline seizure frequency was assessed during the first visit. AED efficacy was determined based on the reduction in seizures from baseline at the subsequent visits. Multivariable ordinal regression analysis was used to determine the association between the clinical factors (demographic characteristics, clinical features, and medication situation) and AED efficacy. For validation, the clinical efficacies of AEDs were compared as both single agents and in combinations. Differences in adverse effect (AEs) categories were analyzed by Chi-square between AED groups.Results: Records of patients receiving VPA, CBZ, and OXC were evaluated. Serum concentrations of VPA and CBZ is significantly correlated with efficacy (OR 1.030 [1.024–1.037], p < 0 0.0001; OR 1.250 [1.146–1.63], p < 0.0001, respectively) and OXC efficacy correlated to the serum concentration of the metabolite 10,11-dihydro-10-hydroxy-carbazepine (monohydroxy derivative, MHD) serum concentrations (OR 1.060 [1.031–1.089], p < 0.0001). Significant differences existed between females and males in VPA efficacy (OR 1.318 [1.033–1.682], p = 0.027). After validation, VPA, in combination with OXC (OR 1.93 [1.38–2.70], p<0.001), or with VGB (Vigabatrin) (OR 2.36 [1.38–2.70], p = 0.002), showed significantly better efficacy than as a single agent. OXC efficacy was also affected by the duration of epilepsy (OR 0.965 [0.946–0.984], p < 0.001). Additionally, the efficacies of OXC and VPA were also affected by the seizure type. Seizure reduction improved significantly with an increasing number of pharmacists’ educations in the first three visits period. There were no differences in AEs incidence among these 3 AEDs except for Psychiatric (0.02) and nervous system disorders (0.0001).Conclusion: Serum concentrations of VPA and CBZ may positively affect their efficacies, while OXC efficacies are correlated to MHD serum concentrations. The efficacy of VPA was higher in females compared to males. VPA-OXC and VPA-VGB combinations had higher efficacies compared to monotherapy. Besides, OXC efficacy is probably reducing by the duration of epilepsy. Additionally, VPA efficacy for focal or generalized seizures is superior to mixed-type seizures. OXC was more effective for focal seizures compared to mixed-type ones. Education provided by pharmacists improved the seizures to some extent, and there were no significant differences between most categories of adverse effects for the investigated AEDs.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

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Evaluation of Factors Impacting the Efficacy of Single or Combination Therapies of Valproic Acid, Carbamazepine, and Oxcarbazepine: A Longitudinal Observation Study

Peng

et al. 2021

Front. Pharmacol.

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“…7 A pharmacist-led education session with patients has been shown to increase adherence in a sustainable manner from 56 to 74%. 26 However, an embedded pharmacist in an outpatient clinic is a luxury that is unavailable to the majority of practitioners. Simplifying antiseizure drug regimens can positively impact adherence, 19,20 and for those patients who are less literate, prepackaged "blister packs" that are clearly marked and contain a single dose may be helpful.…”

Section: Medication Nonadherencementioning

confidence: 99%

Epilepsy: Workup and Management in Adults

O’Dwyer

2020

Semin Neurol

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When managing epilepsy, there is a temptation to focus care with respect to the last and the next seizure. However, epilepsy is a multifaceted chronic condition and should be treated as such. Epilepsy comes with many physical risks, psychological effects, and socioeconomic ramifications, demanding a long-term commitment from the treating physician. Patients with epilepsy, compared to other chronically ill patient populations, have a worse quality of life, family function, and less social support. The majority of patients are well controlled on antiseizure drugs. However, approximately one-third will continue to have seizures despite optimized medical management. The primary aim of this article is to explore the long-term management of chronic epilepsy, and to address some of the particular needs of patients with chronic epilepsy.

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“…Również u dzieci leczonych warfaryną lepszą kontrolę INR obserwowano w grupie pacjentów, których farmakoterapia nadzorowana była przez farmaceutę klinicznego [21]. U pacjentów pediatrycznych chorych na padaczkę leczonych kwasem walproinowym dzięki edukacji prowadzonej przez farmaceutów poprawiła się współpraca pacjentów i opiekunów z personelem fachowym w zakresie przestrzegania zaleceń terapeutycznych, co potwierdziło monitorowanie i analiza stężeń leku w surowicy [22]. Interwencje farmaceuty klinicznego pozwalały osiągnąć także korzyści w aspekcie farmakoekonomicznym poprzez zmniejszenie liczby podawanych leków lub wykorzystanie ich tańszych alternatyw oraz zmniejszenie częstotliwości występowania działań niepożądanych i powiązanych z nimi kosztów [16,17,23,24].…”

Section: Zapobieganie Występowaniu Błędów Lekowychunclassified

Identification of the area of service provided by clinical pharmacist in the pediatric patient care

Nowak¹,

Owczarek²,

Karolewicz³

et al. 2019

Farm Pol.

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Identification of the area of service provided by clinical pharmacist in the pediatric patient care • The interdisciplinary cooperation between medical professions in patient care was indicated as necessary in the joint document of the The International Pharmaceutical Federation and the World Medical Assembly "The relationship between physicians and pharmacists in medical therapy". The available literature emphasizes the role of the clinical pharmacist in clinical departments, such as pediatric cardiac intensive care units, or pediatric nephrology and pediatric oncology units. This work summarizes the literature related to the most important opportunities and benefits of clinical involvement of a pharmacist in the care of a pediatric patient. The law regulations in Poland to the area of pharmacists' activity discussed in the article require supplementing and specifying the most important legal acts related to pharmaceutical law and healthcare legal services. The changes should lead to the clarification of new obligations and support shaping the new professional status of clinical pharmacists employed in hospitals to provide care in the group of pediatric patients.

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Pharmacist impact on adherence of valproic acid therapy in pediatric patients with epilepsy using active education techniques

Cited by 15 publications

References 36 publications

Evaluation of Factors Impacting the Efficacy of Single or Combination Therapies of Valproic Acid, Carbamazepine, and Oxcarbazepine: A Longitudinal Observation Study

Evaluation of Factors Impacting the Efficacy of Single or Combination Therapies of Valproic Acid, Carbamazepine, and Oxcarbazepine: A Longitudinal Observation Study

Epilepsy: Workup and Management in Adults

Identification of the area of service provided by clinical pharmacist in the pediatric patient care

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