Authors (including presenting author) :
Mak SY(1), Chan SC(1), Lau WM(1), Lo KM(2)
Affiliation :
(1) Pharmacy Department, Our Lady of Maryknoll Hospital, (2) Department of Medicine & Geriatrics, Our Lady of Maryknoll Hospital
Introduction :
Prescribing for elderly patients is getting more complicated. Drug related problems may lead to possible harmful outcomes, and increase burden on patients/care-givers and on healthcare system. Physician-Pharmacist Collaborative Medication Management Service provides medication review and counselling with a view to optimize medication management.
Objectives :
The aim of this study was to investigate the magnitude and types of drug related problems in elderly patients based on the third Consensus of Granada on Drug Related Problems (DRPs) and Negative Outcomes associated with Medication (NOM), and to estimate the extent to which pharmacists play their roles in reducing the incidences of DRPs and adverse consequences.
Methodology :
This was a single-arm, prospective study. Pharmacist underwent medication review with subjects aged ≥65 and performed interventions if any DRP(s) was/ were identified upon physicians’ referral. Timely feedback and recommendations were made to medical staff for necessary action as appropriate. In-depth counselling was provided to patients and/or care givers, including pharmacological and non-pharmacological aspects. Cases with medication-related issues were followed up to ensure resolution of the identified issue(s). Drug related problems were quantified and analyzed according to the Consensus of Granada before and after pharmacist’s intervention.
Result & Outcome :
From 4/1/2017 to 3/4/2019, 172 subjects (78.1±8.3 years old) were recruited. The median follow up interval was 78 days. The mean number of DRPs identified was 2.2±1.1 per subject. Out of 1395 drug items taken by the subjects, 342 DRPs (25%) were identified in the first counselling session. After intervention, the number of DRPs were reduced to 110 (8%) in subsequent follow-up sessions. The reduction in the number of identified DRPs after intervention was -232 (p=0.045). The reduction rate of DRPs was -68% (-232 out of 342 DRPs). The most commonly presented categories of DRPs were ‘compliance problems’ (35%, 120 out of 342 DRPs), followed by ‘wrong administered drugs’ (26%, 90 out of 342 DRPs), and ‘probability of adverse effects’ (15%, 50 out of 342 DRPs). Ninety-nine cases of NOM were identified. The study revealed a substantial magnitude of drug related problems leading to adverse outcomes. Proactive medical staff and pharmacist collaborative medication management service provided to elderly patients and/or care-givers helps minimize DRPs and NOM, and achieve desirable therapeutic outcomes.
