January 27, 2025

Initiative-funded pilot develops training for pharmacists to treat people with epilepsy

Epilepsy, a complex spectrum of seizure disorders, which affects about 3.4 million people nationwide, making it the fourth most common neurological disease in the United States. While anti seizure medicines (ASMs) are the first line of treatment, 50% of people living with epilepsy (PWE) experience adverse drug effects that lessen medication adherence and quality of life (QoL).

For nearly five years, a team of interdisciplinary researchers at the University of Washington, which included H. Steve White (Pharmacy), Andy Stergachis (Pharmacy and Global Health), Michelle Guignet (Pharmacy), Jennifer Bacci (Pharmacy), Ben Nwogu (Pharmacy), Sabra Zaraa (Pharmacy), Edward Novotny (Neurology, Pediatrics and Director of Seattle Children’s Epilepsy Program), have worked to develop and implement a training program that educates community pharmacists on how to treat and act as a medical provider for PWE.

Their work began with a literature review and qualitative discussions with pharmacists, neurologists and patients to evaluate the idea of advancing pharmacists’ involvement in providing medical care to their patients. This in turn led to a pilot research grant from the UW Population Health Initiative in 2019, which brought the global biopharmaceutical company UCB to the table to support the team’s effort in improving access to care for PWE. Collectively investigators at UW and UCB Pharma worked to design an epilepsy training program that could change the way community pharmacists interact with their patients with epilepsy.

More recently, the project was awarded a Population Health Initiative Tier 3 pilot grant in spring 2022 to develop and evaluate a training program for community pharmacists’ population health intervention for PWE, and implement and evaluate the impact of the community pharmacist population health intervention on PWE’s quality of life. The team recently shared its final outcome for that project.

Michelle Guignet, acting assistant professor in the UW School of Pharmacy, worked on developing and implementing the training program for six community pharmacists across two independent pharmacies in Washington state from November 2022 to January 2023. “Community pharmacists are one of the most accessible healthcare providers for patients,” said Guignet. “It’s estimated that up to 90% of the American population lives within five miles of a community pharmacy, so there’s somebody that’s very easy for patients to be able to go to and see without an appointment.”

Steve White, a professor in the UW School of Pharmacy, brought 40 years of epilepsy research experience to the project, helping move the idea forward through conceptualization of the program’s trajectory. White also lives with a focal seizure disorder himself and relies on a local community pharmacy to fill his monthly anti-seizure medicine. As a pharmacist and someone who has been actively engaged in epilepsy research for the entirety of his career, White has long felt like the community pharmacist is an underutilized resource when it comes to management of the patient with epilepsy.

“I’m one of the lucky ones in that my seizures are controlled because the medicine I’m taking is doing its job,” said White. “My hope is that through the training program that we have collaboratively developed pharmacists can become more knowledgeable and more competent and confident in their ability to speak with a patient with epilepsy about difficult topics related to their epilepsy journey and the medications that they take.”

The community pharmacist population health intervention was implemented in two independent pharmacies from February to November 2023, followed by an evaluation of the impact of the intervention on patient-reported quality of life (QoL), health, and satisfaction outcomes.

Low patient recruitment resulted in a shift towards understanding the barriers to patient recruitment and refining the intervention with the goal of improving the outcomes and well-being of PWE. Guignet and White mentioned that the pharmacies involved in the initial “roll-out of the program serve a smaller population of people with epilepsy, most of which had control of their seizures with medication; two factors that contributed to low enrollment.

“I think an ‘aha’ moment for us was that these patients, even though they were actually eligible to be a part of the study, were perhaps not the ones that were going to benefit the most from a program like this,” said Guignet. “So identifying those patients who perhaps don’t respond very well to their anti-seizure medicines are the ones that would be probably better served for an implementation service like this.”

Another obstacle is the current state of community pharmacies, which have experienced increased staffing shortages, workload challenges and pharmacy closures. This has prevented the research team from pursuing future funding for projects that enable build off of the progress made in the last three years.

“I think one of the struggles right now is that the populations [pharmacies] served are so large that implementing a program like this is a little bit harder to do,” said Guignet. “A shift that we’re hoping for is that those populations can be better served, that there can be more pharmacists that are brought into the profession that are able to make space for that and to be able to implement these programs a little bit more broadly.”

The research team presented their findings at the American Epilepsy Society 2023 Annual Meeting and were published in the Journal of the American Pharmacists Association. In addition, they recently initiated a collaboration with the International League Against Epilepsy (ILAE) Pharmacy Section, with hopes of aligning the training program with the ILAE Pharmacy Section’s standards in order to scale the program across different practice settings on a global scale.

“This could have not happened without funding from the Population Health Initiative,” said White. “Moving forward, my hope is that we will be able to identify additional resources, maybe do a larger clinical study in a population that has a greater need for an intervention like this, and get the statistical data needed to push this initiative forward to the broader pharmacy community.”