Abstracts

Rationale: Our pediatric outpatient neurology clinic is based in a teaching hospital in Quebec City, Canada. Since September 2012, a clinical pharmacist has been added to the team made up of 5 neurologists and a nurse. This addition aims to facilitate pharmacotherapy optimization between medical appointments. Contact between parents and the pharmacist is made mainly by telephone. To our knowledge, no former publications describe a pharmacist’s role in this setup. Methods: We retrospectively reviewed pharmacy consultations written between January 1 and August 31, 2015. Our main objective was to describe pharmacist activities in the clinic. Specific objectives included the description of the origin and type of consultation as well as pharmacist intervention types. Only patients under 18 years of age with a diagnosed epilepsy condition were included. Results: We reviewed 242 consultations (143 patients) made by the pharmacist. Mean patient age was 8 years old (SD: 4.5). Generalized epilepsy was diagnosed in 65% of cases. Patients were mostly treated by monotherapy (48%) or bitherapy (24%). Patients on 3 or more antiepileptic drugs required more consultations than others (2.3 Vs 1.4/patient). Drugs prescribed included valproic acid (VPA) (56%), clobazam (23%), carbamazepine (18%) and lamotrigine (17%). Most consultations originated from lab reception (61%), parent phone calls (18%) and pharmacist initiative (12%). Therapeutic drug monitoring (TDM) was the main reason for consultation (62%). A total of 164 blood levels were analysed: 102 (62%) for VPA, 34 (21%) for carbamazepine, 17 (10%) for phenytoin and others. Concentrations were within the therapeutic range in 51%, 89% and 62% of cases for these drugs respectively. VPA levels tended to be low with 47% being subtherapeutic while 23% of phenytoin levels were supratherapeutic. Treatment failure (51%) and adverse reaction (16%) were the main reasons for which parents contacted the pharmacist. Other frequent reasons for consultation were pharmacotherapeutic evaluations (PE) (25%) and patient follow-up (10%). PE were mainly done following treatment failure (45%) or adverse reactions (13%). At least one intervention was made by the pharmacist in 62% of consultations, for a total of 215 interventions. Major types of interventions included blood test prescription (37%) and dosage increases (35%). Other types of interventions included dosage reduction (5%), drug addition (5%), drug discontinuation (3%) and therapeutic substitution (3%). Conclusions: TDM represents an important workload for the pharmacist involved with pediatric outpatients with epilepsy. It is especially the case when VPA is initiated. In this population with relatively simple pharmacotherapy, dosage increases are common. Our setup allows easy access to a specialized healthcare provider in case of treatment failure or adverse events. Funding: No funding was received in support of this abstract.