Authors (including presenting author) :
Ho VKW (1), Leung SYP (1), Li CHY (1), Chui WCM (1), Tse HF(2), Chan CWS (2)
Affiliation :
(1)Department of Pharmacy, Queen Mary Hospital, Hong Kong; (2)Department of Medicine, Queen Mary Hospital.
Introduction :
Heart failure (HF) is associated with high hospitalization rate and significant healthcare burden. Multiple comorbidities, follow-up appointments at different specialty clinics and hospital admissions can result in frequent change of medications, complicating the drug therapy management. Despite the positive outcomes demonstrated by overseas studies, involvement of Clinical Pharmacists in the management of HF has not been established in Hong Kong.
Objectives :
This study is to evaluate the impact of a Clinical Pharmacist Collaborative Heart Failure Programme on HF patient care in Hong Kong.
Methodology :
This was a randomized controlled study in Queen Mary Hospital. One hundred and seventy-one HF patients with at least two HF-related admissions during the past one year were randomized into intervention and control group. For the intervention group, Clinical Pharmacist’s consultation was arranged in outpatient clinic prior to physician consultation for reviewing medications, recommending therapeutic interventions to physicians and solving Drug-related problems (DRPs) of patients. Other study interventions included regular tele-monitoring and post-discharge phone counselling. The primary outcome was the difference in HF-related hospitalizations over one year while secondary outcome was the difference in all-cause hospitalizations over one year. DRPs, pharmacist interventions and physician’s acceptance to interventions were analyzed as sub-group analysis.
Result & Outcome :
At the time of this interim study, the target number of patients was not reached. After the mean follow-up period of 527 days, there was a trend towards less HF-related hospitalizations in the intervention group (OR 0.440, p=1.112). Numbers of all-cause hospitalizations were similar (OR 0.997, p=0.969). These differences did not reach statistical significance at this interim report. Total number of DRPs and interventions suggested to doctor was 266 and 182 respectively. Pharmacists’ interventions were well accepted by physicians (acceptance rate=79%). This study showed a trend of reduction in HF-related hospitalizations by involving Clinical Pharmacists in the HF patient care. The high number of DRPs identified and high physician acceptance rate to pharmacist interventions highlighted the Clinical Pharmacist’s roles in enhancing patient safety and improving quality of care in HF patients. The positive outcomes support the development of a multidisciplinary HF care team involving Clinical Pharmacists. The study will be continued for further subject recruitment and longer follow-up duration to investigate the long-term impact of the Clinical Pharmacist Collaborative Heart Failure Programme.
