Pharmacist-based Donepezil Outpatient Consultation Service to improve medication persistence

Abstract

Aim: Donepezil is widely used to delay the progression of cognitive dysfunction in patients with Alzheimer's disease (AD), but the efficacy of pharmacotherapy is often reduced by poor adherence to medication. In order to improve adherence by providing information about AD and the significance of pharmacotherapy, the Donepezil Outpatient Consultation Service (DOCS) was set up. The influence of this service on medication persistence was assessed in the present study.

Methods: Among outpatients starting donepezil therapy, we enrolled 59 patients between April 2008 and September 2010 before establishment of the DOCS (non-DOCS group) and 52 patients between October 2010 and March 2012 who attended the DOCS (DOCS group). Each patient's and their caregiver's understanding about the clinical features of AD and pharmacotherapy with donepezil were also assessed. Their understanding was compared before and after the DOCS, and the 1-year medication persistence rate and the reasons for discontinuation were also investigated.

Results: The 1-year medication persistence rate was significantly higher in the DOCS group than in the non-DOCS group (73.1% vs 49.2%, P = 0.008). We examined the association of medication persistence with age, sex, clinical dementia rating, living alone, and attending the DOCS. As a result, medication persistence was significantly higher in patients attending the DOCS. The main reasons for discontinuation of donepezil were transfer elsewhere (11) and gastrointestinal side effects (5) in the non-DOCS group, and transfer (9) and gastrointestinal side effects (3) in the DOCS group. The overall score for understanding was 2.5 ± 1.7 before attending the DOCS and it increased significantly to 5.7 ± 0.7 afterward (P < 0.001).

Conclusion: The DOCS consultation provided by hospital pharmacists for AD patients and their caregivers improved understanding about the clinical features of dementia and provided pharmacological knowledge about antidementia drugs, leading to better adherence to pharmacotherapy that could maximize its effect.

Keywords: Alzheimer’s disease; cholinesterase inhibitors; consultation; donepezil; patient knowledge; pharmacists.

Figure 1

(A) Level of understanding about the clinical features of Alzheimer’s disease and pharmacotherapy with donepezil in primary caregivers before and 4 weeks after the first DOCS consultation. (B) Number of primary caregivers giving correct answers about the clinical features of Alzheimer’s disease and treatment with donepezil before and 4 weeks after the first DOCS consultation. Notes: *P < 0.001; Wilcoxon’s signed-rank test. Abbreviation: DOCS, Donepezil Outpatient Consultation Service.

Figure 2

Persistence with treatment in the DOCS and non-DOCS groups. Abbreviation: DOCS, Donepezil Outpatient Consultation Service.