Pharmacist-managed telephone clinic review of antidementia medication effectiveness.

Objective: To describe the development and implementation of a telephone clinic for evaluating continued effectiveness of antidementia medication therapy in patients with dementia.

Setting: Ambulatory care at the Veterans Affairs Salt Lake City Health Care System.

Practice Description: A pharmacist-directed, telephone dementia clinic review of patients taking dual antidementia therapy to determine whether a medication-discontinuation trial is appropriate based on caregiver global impressions.

Practice Innovation: Pharmacists review eligible patients' electronic medical records for adherence history and caregiver impressions of response to antidementia medications to determine if a discontinuation trial of antidementia medication is warranted. Pharmacists coordinate any discontinuation discussion with caregivers and medical providers and monitor patients' response to the resultant interventions via telephone.

Main Outcomes: Pharmacist involvement allows for a structured method of monitoring adherence with antidementia medications and for determining whether they continue to provide benefit.

Results: Expected results include percentage of patients who underwent a medication-discontinuation trial, percentage of patients who did not demonstrate clinical decline after a discontinuation trial, and percentage of patients who subsequently restarted medication because of noticeable decline after the discontinuation trial.

Conclusion: This telephone clinic capitalizes on the expertise of clinical pharmacists and helps establish a functional collaboration between health care providers, patients, and the electronic medical record to obtain a multiperspective evaluation of the effectiveness of antidementia therapy from a patient-centric view. This systematic approach improves patient-centered care and may have favorable impacts on antidementia medication cost utilization.