Authors (including presenting author) :
K L Lin(1), C Fan(2), K Y TSANG(1), E LI(2), H Chan(2), T Leung(2), C Wong(2), A Liu(2), Y Po(1), C Kng(1)
Affiliation :
(1)Community Geriatric Assessment Services, Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals
(2)Department of Pharmacy, Pamela Youde Nethersole Eastern Hospital
Introduction :
Multi-morbidity is common in elderly, leading to polypharmacy, multiple prescribers and drug interactions, with risk of adverse outcomes. Pharmacy input is critical to this escalating problem of medication management. The Hospital Authority Drug Refill Services (DRS) in HKEC introduced an opportunity for inter-disciplinary cross-sectoral partnerships between PYNEH pharmacy, HKEC Community Geriatrics Assessment Service (CGAS) and Residential Care Homes of the Elderly (RCHE).
Objectives :
The aims were to reduce the burden of polypharmacy through a refill scheme and provide timely review of medication changes to avoid adverse patient outcomes.
Methodology :
Interdisciplinary roles were defined for pharmacists, CGAS doctors and nurses and RCHE nurses. Target patients were RCHE patients with ≥16 weeks prescriptions by CGAT doctor, ≥8 medications, and multiple prescribers or care transitions. Outcomes for risk reduction were defined as identification of omissions or duplication, drug interactions or preferred alternatives by pharmacist. Outcomes for burden reduction were indicated by decreased dispensed medications and storage in RCHE. Patient or carer satisfaction was recorded by questionnaire.
Result & Outcome :
Results – HKEC CGAT covers 75 RCHEs, with 31 RCHEs included in this phase of the program. CGAT specialist clinic supports 78% (n=1956) of 2500 residents, with follow up clinic interval ≥16 weeks in 1893 (96%), of which 1219 (64%) take ≥8 medications and 1131 (92%) have multiple admissions or consultations. Excluding patients with dual follow up, 791 was recruited into DRS. From 25 Feb 2019 to 30 Sept 2019, 655 of 794 refill prescriptions were dispensed, of which 45% (297) had refill quantity reduced and 15% (100) refill aborted. Pharmacy provided 80 carer or patient empowerment and 41 recommendations adopted by CGAT doctors to improve prescribing quality, of which 33 (80%) related to therapeutic duplication, inappropriate duration of therapy or drug choice, or insufficient stock. Additional to drug savings ($43,619), the reduced burden of storage and medical waste disposal at RCHE received positive feedback from RCHE staff and CGAT staff feedback welcomed the collaboration with pharmacy.
Conclusion - This new interdisciplinary medical social collaborative care model for RCHE patients offers a sustainable means to reduce the huge medication burdens and its inherent risks for an increasingly frail aged population.
