Authors (including presenting author) :
Li NHC(1), Chu PLM(1), Young GWM(1), Lee JCF(1)
Affiliation :
(1)Department of Pharmacy, Tuen Mun Hospital
Introduction :
Drug Refill Service (DRS) has been implemented in Tuen Mun Hospital since December 2017. Patients aged ≥60 years old with multiple follow-ups and polypharmacy are enrolled. Specialist Out-patient Clinic (SOPC) prescriptions of these patients under Medical and Geriatrics (MG) and Community Geriatric Assessment Team (CGAT) with dispensing duration ≥17 weeks are split into two or more installments based on prescription duration. Before dispensing next drug refill to patient, pharmacist will review and reconcile cases with medical consultations, hospitalizations or updated drug dispensing records since last SOPC consultation. However, further risk stratification has not been done to prioritize healthcare resources for better patient care.
Objectives :
(1)To study the types of medical consultations occurred in DRS patients between first consultation and upcoming medication refill, and (2)to evaluate the corresponding impact on dispensing outcomes of refill medications.
Methodology :
DRS refill orders with due date from 1/9/2019 to 31/10/2019 were included. Documentations per each refill order were retrieved from DRS Telephony System which pharmacists recorded reconciliation and dispensing outcomes of each refill medications in the system. Patient demographics, refill due date, types of medical consultations or hospitalizations, corporate drug dispensing record updates, refill medication changes and dispensing outcomes of refill order were extracted and further analyzed. Cases with no medical consultation records documented were excluded from analysis.
Result & Outcome :
A total of 910 cases were reviewed. The mean number of medical consultations occurred per each refill order was 1.98. The most common medical consultations were SOPC appointment (54.7%), hospitalization (16.3%) and General Out-patient Clinic appointment (14.4%). Most medical consultations did not lead to a change in refill medications (90.9%). MG hospitalizations (37.6%), Nurse Clinic appointments (26.0%), and surgical hospitalizations (18.4%) were the main medical consultations leading to drug changes. Despite SOPC consultations from Ophthalmology (n=221) and Psychiatry (n=196) commonly occurred, only 2 Psychiatry consultations and nil from Ophthalmology contributed to a change in refill medications. Common reasons for change in refill medications include change of dosage (47.1%) and discontinuation (31.1%). Medication changes from class of cardiovascular system (46.7%) and endocrine system (26.7%) were commonly observed. There were 53 refill cases (5.82%) aborted from dispensing. Most cases (88.7%) were already dispensed all medications before upcoming refill due to an unplanned medical consultation. This study provides guidance for pharmacist to categorize patients and identify medical consultations prone to medication changes. Subsequent prioritization of healthcare resources through big data analysis could offer more comprehensive pharmaceutical review and risk management.
