Ambulatory Care of Children Treated with Anticonvulsants – Pitfalls after Discharge from Hospital

Abstract

Background:

Anticonvulsants require special consideration particularly at the interface from hospital to ambulatory care.

Patients and method:

Observational study for 6 months with prospectively enrolled consecutive patients in a neuropediatric ward of a university hospital (age 0–<18 years) with long-term therapy of at least one anticonvulsant. Assessment of outpatient prescriptions after discharge. Parent interviews for emergency treatment for acute seizures and safety precautions.

Results:

We identified changes of the brand in 19/82 (23%) patients caused by hospital’s discharge letters (4/82; 5%) or in ambulatory care (15/82; 18%). In 37/76 (49%) of patients who were deemed to require rescue medication, no recommendation for such a medication was included in the discharge letters. 17/76 (22%) of the respective parents stated that they had no immediate access to rescue medication. Safety precautions were applicable in 44 epilepsy patients. We identified knowledge deficits in 27/44 (61%) of parents.

Conclusion:

Switching of brands after discharge was frequent. In the discharge letters, rescue medications were insufficiently recommended. Additionally, parents frequently displayed knowledge deficits in risk management.

Zusammenfassung

Hintergrund:

Antikonvulsiva erfordern besondere Aufmerksamkeit an der stationär-ambulante Schnittstelle.

Patienten und Methode:

Prospektive Beobachtungsstudie über 6 Monate mit konsekutiven Patienten einer neuropädiatrischen Station einer Universitätsklinik (Alter 0–<18 Jahre) unter Dauertherapie mit mindestens einem Antikonvulsivum. Analyse der ambulanten Antikonvulsiva-Verordnungen nach Entlassung. Elterninterviews zu Notfallbehandlung und Vorsichtsmaßnahmen bei akuten Anfällen.

Ergebnisse:

Wir identifizierten Fertigarzneimittelwechsel bei 19/82 (23%) Patienten, bedingt durch Entlassungsbriefe des Klinikums (4/82; 5%) oder in der ambulanten Versorgung (15/82; 18%). Bei 37/76 (49%) der Patienten mit Notwendigkeit für ein Notfallmedikament war keine solche Empfehlung in den Arztbriefen enthalten. 17/76 (22%) der betroffenen Eltern gaben an, kein Notfallmedikament verfügbar zu haben. Vorsichtsmaßnahmen waren bei 44 Epilepsiepatienten angezeigt. Wissensdefizite zeigten sich bei 27/44 (61%) der Eltern.

Schlussfolgerung:

Fertigarzneimittelwechsel nach der Entlassung waren häufig. In den Entlassungsbriefen wurden Notfallarzneimittel unzureichend empfohlen. Zudem hatten Eltern häufig Wissensdefizite zu Vorsichtsmaßnahmen.

Key words

anticonvulsants - ambulatory care - children - adolescents - compliance - generic drugs - risk management

Schlüsselwörter

Antikonvulsiva - ambulante Betreuung - Kinder - Jugendliche - Compliance - Generika - Vorsichtsmaßnahmen

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