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Prescribing & Medicines Management
Issue no 3, p3
May/June 2003

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DoH bids to improve epilepsy care through medicines management

Clinicians involved in the national "sudden death in epilepsy" audit will take part in future national medicines management collaborative workshops in a bid to improve the deficiencies in drug management highlighted by the report.

The move comes one year after the first national sentinel audit of epilepsy-related deaths, which found that up to 39 per cent of adult deaths investigated were potentially avoidable. The Department of Health's action plan published last month (May) aims to support the development of medicines management strategies to improve patient care.

The audit was published by the charity Epilepsy Bereaved in May 2002. In all, 152 of the 2,400 deaths in 1999–2000 in which epilepsy had been mentioned on death certificates were investigated. Drug management was considered inadequate in 20 per cent of adults and 45 per cent of children studied.

Three quarters of adults were receiving one or two antiepileptic drugs, although 6 and 18 per cent of adults and children, respectively, were not receiving any medication when they died. Problems identified included no medication prescribed despite continuing seizures, inadequate doses or inappropriate combinations of drugs prescribed, unsupervised management of changes to medication and a lack of consideration for alternative choices of antiepileptic drugs.

Adherence with prescribed medication was judged poor in 14 per cent of secondary care cases, and in primary care up to a quarter of patients with a drug record ordered their medication late, indicating problems with adherence.

The DoH said that the Task Force on Medicines Partnership would explore during the next year how to improve shared decision making around epilepsy medication between patients, neurologists, specialist nurses and pharmacists.

York GP Dr Henry Smithson, one of the report's authors, said: "My view is that medication review is best done by GPs who know the patient well. I would have concerns about a high street pharmacist offering advice on epilepsy medication." But he added that pharmacists might play a useful role in helping to identify patients who were having problems taking their medicine.

The audit is available as a PDF file (1.5MB).

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