Assessment of quality of chronic care in patients with epilepsy

The aim of this study was to assess the quality of chronic care provided to adult patients with epilepsy, identify clinical pharmacy interventions for potential risks arising from inadequately delivered care services, and evaluate the impact of clinical pharmacy services on patient outcomes. The study was conducted prospectively in four phases between February 2022 and June 2023 at the Neurology outpatient clinics of Hacettepe University Hospitals. In the first period (3 months), the quality of care of 162 patients was determined observationally with the quality indicators (QI) checklist and in the second period, clinical pharmacy services were defined by the expert panel for potential risks that may occur due to non-adherence with quality indicators. In the third period (12 months), 154 patients received clinical pharmacy services and the changes in seizure frequency, medication adherence (Medication Adherence Reporting Scale, MARS), personal impact of epilepsy on the patient (Personal Impact of Epilepsy Scale, PIES), quality of life (Quality of Life in Epilepsy, QOLIE-10) and depression (Patient Health Questionnaire, PHQ-9) were evaluated during the 6-month follow-up period. In the fourth period (3 months), the QI checklist was provided to physicians and adherence rates were re-assessed for 162 patients. In the first period, the highest adherence rates were observed in QI-1a (96.3%) and QI-10 (100%), while the lowest compliance rates were found in QI-7, QI-8, and QI-9. The patient education on treatment adherence, side effect monitoring, lifestyle, and quality of life was planned as part of the clinical pharmacy services during the expert panel meeting. Significant improvements were detected in seizure frequency, MARS, PIES, and QOLIE-10 scores during the third period (p<0.001). In the fourth period, it was observed that the rates of adherence to QI-2a (p=0.032), QI-3d (p=0.012), QI-4 (p=0.001) and QI-5 (p=0.002) significantly increased. This study shows that routine care services have low adherence to QIs, and the importance of clinical pharmacy services developed against potential risks.