Epilepsy Specialist Pharmacists: The Value - Trudy Thomas, Medway School of Pharmacy
Epilepsy Specialist Pharmacist Trudy Thomas explains the incredible value of the role and how and why non-specialist pharmacists should learn more about the epilepsies.
Reported by Torie Robinson | Edited and produced by Pete Allen
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00:53 Trudy Thomas
My name is Trudy Thomas and I'm a pharmacist by background and I specialise in epilepsy. I have sort of a number of different ways in which I do that. So, but mainly on a Friday I work at Medway Maritime Hospital, which is in Kent in the southeast of the UK. And I work as an Epilepsy Specialist Pharmacist there as part of the neurologist team.
And in particular, my sort of special area, I guess, is looking at patients who've got complex medication needs. And so that would include everything through, they've just got a long list of other medicines, because obviously as a pharmacist, I can look at other medicines aside from just their anti-seizure medicines, but it also might be people who are having perhaps particular difficulties with aspects to do with their medication. So maybe they're having a new medicine put in or another one taken out. And...and also, part of that is I can prescribe, so I'm an independent prescriber, so I do quite a lot of prescribing, so that we can perhaps just give people a little bit more help when those medicines are going in and out.01:55 Torie Robinson
So, does that mean that if a person might be in need of a change of medication, they don't need to see their neurologist or their epileptologist; you can actually make that decision for them?
02:04 Trudy Thomas
Yes, yeah, it's often following the plan that's made by the neurologist, but you know, because I've been working with these guys for quite some time, I kind of know the sorts of things that they would and wouldn't do. So yes, I mean, we work very collaboratively, so I can always run down the corridor and, you know, what do you think about this? But yes, certainly I can initiate medication and titrate that up or take it out as required.
02:30 Torie Robinson
And is this with adults and children or just adults?
02:33 Trudy Thomas
Just adults.
02:34 Torie Robinson
Okay, so I can already say, I wish we had more of you and people like you qualified in what you do, et cetera, and who have your passion for what you do.
02:42 Trudy Thomas
Yeah, absolutely. So, there aren't many epilepsy specialist pharmacists. I think there's probably a couple of others that I've come across who are working in a similar sort of role. And I think, you know, before I started, maybe it wasn't even a thing. So, the other part, as I said, I do a number of things, but one of the other parts of my role is I work at a school of pharmacy where we're training students to become pharmacists, and so, you know, I'm a great believer in if you can see one, you can be one. So I'm really keen to promote the fact that you could be an epilepsy specialist pharmacy. It's a thing and you could be one when you grow up. I still haven't grown up yet, but you know, we're working on that. So, yeah, so I think that's, you know, I'm thinking about my kind of legacy, I guess, as I'm getting older and the idea that other pharmacists would specialise in epilepsy.
I think it's a fabulous condition for a pharmacist to specialise in because it's all about the drugs, you know, and so, and as a pharmacist has said, you can, it's not just about the anti-seizure medicines, it's about the medicines as a whole.
03:46 Torie Robinson
Would you say that people who are going to be in a similar role to yourself in the future, would you find they were dealing with challenges other than the seizures? So, things that are commonly accompany seizures, so like psychiatric issues or movement disorders or... tell us about that.
04:04 Trudy Thomas
Sometimes we can sort seizures out quite quickly, but I always think of it as, you know, it can be a case of a sort of a bit of a wonky stool and we get, you know, get the seizures sorted out and then actually that can cause behaviour problems, particularly, you know, if people have got learning disability or it can cause sleep problems or other side effects. And so, sometimes we're trying to get that sort of balance between trying to get the best seizure control we can for people and minimum side effects. You know, I mean, the holy grail is to have no seizures and no side effects, but, you know, sometimes that isn't possible. So it is a case of just sometimes just making kind of quite small changes which we hope can have a good effect for people.
04:44 Torie Robinson
Do you feel that sometimes you have to work with people to accept compromises when it comes to medication? Like, often we'll say that for instance, anti-seizure medications can cause, you know, it can impact cognition to a degree or make you really sleepy and stuff like that.
04:58 Trudy Thomas
Yeah, I think it's about managing people's expectations and, sometimes, perhaps you're trying the 4th or 5th anti-seizure medication for someone and statistically, they're less likely to respond but somebody will! I can remember one guy, quite a young chap, and we were on to about the 4th or 5th thing and it was just like a miracle! He barely had to get the medication out of the box and he was seizure-free and he was like, “Why didn't you give me this before?!”, and I was like, “Oh, sorry, you know, we normally try the other things first...”. So, yeah, so, you know, I think there is… we've got to be realistic about what we can achieve, but I think that, you know, quite often see people who haven't tried different things and they're saying “Oh, well, I only have one seizure a week, so it's not that bad.” and I'm like “That's terrible!” you know, “Come on, we can do better than that for you.”.
05:47 Torie Robinson
What part do you play when it comes to things other than seizures? So do you help with SSRIs? Do you help with other types of medications?
05:54 Trudy Thomas
My scope of practice for prescribing is around the anti-seizure medications and other things, sort of folic acid, vitamin D; those kind of supportive meds. But, so, one of the big, I guess a big part of my role is to work with GPs when we're looking… so, if I pick up that somebody is quite severely depressed and so sometimes the GPs can be a bit reluctant if patients have got epilepsy because they're a bit nervous about doing that. So, I can kind of say to them, these are the sorts of things that would be suitable for somebody with epilepsy. And then the GP can actually make the decision based on the rest of the patient's history (they're gonna have a more detailed history than I will and know what things people have tried in the past). But that sort of, hopefully that gives them at least a little bit of a starter and they can always come back to me. So, and they will, the GPs will come back and say, well, I'm not sure about this and how's that gonna impact that? So again, we can give them advice without me actually saying, they shall prescribe “this”, you know, it's their, it's obviously their prescribing decision, but, but hopefully we've given them some information to make it a bit easier for them.
07:00 Torie Robinson
And that's a really important thing, isn't it, that we have, especially for when it comes to patients affected by the epilepsy, is that there is a good communication between pharmacists and GPs and, well, kind of everybody in the sphere.
07:13 Trudy Thomas
Yeah, yeah, absolutely. And I think, you know, part of, because I keep saying I have lots of different roles (!). So, another role, that I do, collecting jobs (!). So another role that I have been doing, and hopefully will do again (it's sort of stalled for the moment), is a kind of across the whole of our area. So, I cover Kent and Medway, which is a county in the southeast of England. And so, I've been trying to work across primary and secondary care, so to improve communications and I work very closely with the consultant neurologist in the different areas, in the different acute trusts. And it's trying to help them understand what the pressures are in primary care and vice versa. So, it's really trying to help them to do the best for that particular patient, I think. And it can be hard. And a classic example, and you and I talked about this before, so I do a lot of the annual Valproate reviews across the whole of Kent and Medway and I think again a pharmacist is in a really strong position to be able to do that because we've got, you know: here we're trying to look at whether the valproate is the most appropriate medication for that particular woman of childbearing potential and that comes with the epilepsy or the neurology specialist but those people are not specialists in the contraception side which is the other aspect of it, and so you know and they shouldn't have to be: they're neurologists! And then, but then we've got the GPs who know about the contraception side of it, but they don't know about the epilepsy, so having somebody who can help to sort of join those two things up... and again, although I don't prescribe contraception, I can advise on that for the GPs and say, “Well, you know, for this particular patient with this particular medication, this, this and this would be suitable, but this would be less suitable”. So, again, I think it's, you know, a pharmacist in a good position to try and bring those two things together.
09:05 Torie Robinson
It would appear that teaching or lecturing medical students about the epilepsies and those who are becoming pharmacists doesn't necessarily get the time that it should... What is your opinion on that and why should we give more time to teach people about the epilepsies?
09:23 Trudy Thomas
Well, I'm totally biased, aren't I? I think we should, the whole course should be on… I mean, I think we've got to be realistic what we can achieve, and one of my kind of, particular, personal passions is around trying to help what you call the non-specialist, the “jobbing pharmacist”, you know, that you might meet in your community pharmacy when they're dispensing your medicines or where they're working in your GP practice, supporting the GPs there with Medication issues. It's about helping those “non-specialists” to use the skills and abilities that they have already to help people with epilepsy. And I think, you know, like a lot of healthcare professionals, pharmacists have got that “neurophobia”, epilepsy, it's all very scary. And actually, what I'm saying to them is you've got a lot of things in your, you know, your cupboard already that would be a benefit to patients with epilepsy. You know, pharmacists know about interactions - that's really important. They know about which medicines can you give as a brand and which can you give as generics. They know about those sorts of things. So, so I think it's, I'm hoping, that I can give those non-specialist pharmacists confidence to be able to engage more with patients with epilepsy. That's what I want to do. So going back to your… sorry, I've gone off-piste, but in terms of thinking about the amount that they get in their kind of undergraduate training, I think we could give them those basic skills. So as long as they're good at the interactions and they're good at communication. And so those are the things that will serve them well. And then if we can add in a little bit of epilepsy knowledge as well, then I think then we're in business.
11:00 Torie Robinson
I think it could be amazing. I mean, I'm a person who goes down to the pharmacist, I see the pharmacist every so often, and I would really appreciate it if I just had a random question, you know, maybe I don't have access to see an epilepsy nurse over the next week or two because they might not come back to me, or whatever it might be. Because you have direct contact with a pharmacist much more frequently, they can play a crucial and really sort of powerful, impactful, have an impact on people's lives for the better, right?
11:28 Trudy Thomas
Yeah, yeah, absolutely. And that's, you know, as I say, that's a big part of what I'm hoping to do is to inspire those community pharmacists, just, you know, I say to them, “It doesn't matter if you don't know the answer, the fact that you're taking an interest in people with epilepsy…”, because I think people with epilepsy get such a raw deal, you know, all of the, you know, when we've looked at the sort of services that pharmacies can offer, and there's a huge amount of services out there, NHS services, smoking cessation, all those things... Often patients with epilepsy don't get off of those things because again, there's that nervousness. And I think just being honest and saying “Actually, I don't know a huge amount about epilepsy, but I'm sure I can help you…” or “What would you like to know? I'll go and look it up and come back.”. And so, I think that there's a lot that non-specialist pharmacists can do to help patients with epilepsy.
12:16 Torie Robinson
I completely agree - we're talking about helping people to improve quality of life, we're talking about minimising risk, even saving lives. Like, you have just said, it doesn't necessarily require much knowledge initially, you can just learn. It's actually a really, really interesting topic where you can have a massive impact on not solely the individuals with the diagnosis, but their families and the overall society.
12:38 Trudy Thomas
Yeah, yeah. And I think one thing that I hear in my clinic, very, too often actually, is that people say, oh, you know “I like talking to you because you listen to me and you believe me.”. And who's not listening to these people?! Who's not believing these people?! Because I'd like to know! You know, so every pharmacist could do that if nothing else. And so, yeah, I think there's a lot of work to be done.
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Trudy joined the Medway School of Pharmacy in 2004 as a clinical lecturer and was joint Head of Clinical and Professional Practice for six years. She is currently Director of Taught Graduate Studies. She has been the Pharmacist Programme Lead for the School’s Postgraduate Certificate in Independent and Supplementary Prescribing since 2004 and has edited a book ‘Developing your Prescribing Skills’. Trudy was part of the pharmacy planning team for the Olympics and worked at the Stratford Pharmacy during the games. She is a keen runner, swimmer and cyclist.
After qualifying as a pharmacist in 1988 Trudy combined community pharmacy work with pharmacy education work and being a mum. She worked initially for the Centre for Pharmacy Postgraduate Education and the National Pharmaceutical Association, as well as a number of Kent-based Primary Care Organisations, as a Prescribing Advisor.
Over the last five years Trudy has developed a clinical interest in epilepsy, qualifying as a non-medical prescriber in epilepsy in 2016. She works with the local CCG to carry out annual reviews in which she prescribes for people with epilepsy. She still practices as a locum pharmacist.
Research interests
Trudy’s research interests were initially to do with physical activity and behaviour change. In 2014 she completed her PhD which investigated whether community pharmacists can use behaviour change counselling to increase the amount of physical activity undertaken by people with mild to moderate depression. This work was initially supported by a Hugh Linsted Award from the Pharmacy Practice Research Trust.
More recently Trudy has started to develop a research interest in epilepsy to run alongside her clinical speciality. She has been working with local health organisations to support pharmacists to deliver medicines use reviews in epilepsy. She obtained a School scholarship and now has a PhD student who is looking at the medicines burden for people with epilepsy.
Trudy has also undertaken work to evaluate pharmacy services including supporting a PhD which looked at the introduction of the Italian Medicines Use Review Service focused on asthma, Trudy has also been involved in a wide range of service evaluations on behalf of NHS trusts, clinical commissioning groups and the regional Health Education England organisation.
She has an interest in prescribing and is supporting a PhD looking at the effect that prescribing is having on the role identity of physiotherapists. She has also published alongside other members of the Olympic Pharmacy Team and has an interest in drugs in sport.
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LinkedIn: trudy-thomas
Medway School of Pharmacy: trudy-thomas
Researchgate: Trudy-Thomas-3
The Pharmaceutical Journal: trudy-thomas
Amazon: Developing Your Prescribing Skills: https://amzn.eu/d/f0y3pMo
Sports Oracle: trudy-thomas
British Journal of Sports Medicine: https://bjsm.bmj.com/content/57/1/40.info
Royal Pharmaceutical Society: list-of-current-fellows
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