Community pharmacists' knowledge of Alzheimer disease care in high- and low-income Chicago

Objectives

This pilot study examined community pharmacists' knowledge to provide care and services for persons with Alzheimer disease (AD) and area income-based disparities in knowledge and availability of cognitive enhancers.

Methods

A cross-sectional telephone survey of pharmacies (n = 137) in high- and low-income areas in Chicago was conducted on pharmacists' degree, experience, and continuing education, as well as knowledge of AD disease and treatment expectations, adverse effects (AEs) of donepezil, and self-care recommendations for insomnia. Pharmacies were selected from highest- and lowest-income zip code areas, defined using household area median incomes from the 2008-2012 American Community Survey 5-Year Estimates. In-stock availability of select cognitive enhancers was obtained. Chi-square, Fisher exact test, and simple and multiple logistic regression analyses were performed with the use of Stata 10.1.

Results

Odds were 70% lower that pharmacists in low-income areas would say there was nothing to reverse the course of AD (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13-0.70) and 7 times greater that they would recommend a medication to reverse the course of AD (OR 7.04, 95% CI 2.19-22.62) compared with pharmacists in high-income areas. Odds were more than 50% lower that pharmacists in low-income areas would name at least 1 adverse effect for donepezil (OR 0.42, 95% CI 0.19-0.92) compared with peers in high-income areas. Pharmacies in low-income areas had lower odds of having 4 of the 5 surveyed formulations of cognitive enhancers in stock.

Conclusion

It is concerning that 20%-30% of pharmacists recommended a medication to “reverse” the course of AD, about one-half of pharmacists could not mention a single adverse effect of donepezil, and more than one-fourth of pharmacists made an inappropriate self-care sleep aid recommendation for a person with AD who was using rivastigmine patch. Although overall results regarding pharmacists' knowledge were poor, performance was significantly poorer in low-income areas. As our AD population increases, we need to strengthen pharmacists' knowledge on and competencies important for pharmacy-related AD care.