Authors (including presenting author) :
Tam HM(1), Wong MY(2), Fan SY(1), Liu HK(1)
Affiliation :
(1) Pharmacy Department, Pamela Youde Nethersole Eastern Hospital (2) Family Medicine & Primary Healthcare, Hong Kong East Cluster
Introduction :
Poor drug adherence can lead to suboptimal disease control and increased healthcare cost. The pharmacist-led Medication Management and Compliance Clinic (MMCC) aimed to improve drug compliance and patient clinical outcomes by assessing drug-taking behaviour and providing medication reconciliation, counselling, education, and pharmaceutical care.
Objectives :
To investigate the clinical impact of pharmacist-led MMCC on drug compliance and therapeutic outcomes.
Methodology :
A retrospective review of the clinical impact of pharmacist-led MMCC was performed during 1/1/2020 to 31/8/2020. Patients were referred to attend the MMCC by either doctor or pharmacist. Referral criteria included patients who have (1) polypharmacy (>4 chronic medications), (2) potential adherence problem, (3) suffered from hypertension, diabetes, and/ or dyslipidaemia who did not achieve treatment goals, (4) recently admitted to hospital, or (5) taking high-risk medications. MMCC follow-up would be arranged for patients with drug adherence or drug-related problems. The primary outcome is the change in drug adherence among patients with drug adherence problem at initial MMCC visit. The secondary outcome is the change in clinical parameters after attending MMCC among patients with accepted clinical interventions provided by pharmacists, including haemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and urine albumin to creatinine ratio (ACR).
Result & Outcome :
There were 2546 MMCC attendances during the review period. 755 patients had at least one MMCC follow-ups and were analysed. 196 patients (196/755:26%) had drug adherence problem at the initial visit. 147 patients (147/196:75%) had an improvement in drug adherence at MMCC follow-ups. Improved clinical parameters were observed after MMCC attendance. Improvement in HbA1c (mean reduction 0.37%) and LDL-C level (mean reduction 0.09mmol/L) were observed in 226 patients (226/399:57%) and 146 patients (146/448:33%) respectively. 383 patients (383/735:52%) had lower systolic BP on clinic attendance (mean reduction 2.51mmHg) and 69 patients (69/232:30%) had improvement in ACR (mean reduction 2.70mg/mmol) after attending MMCC. Among the 80 accepted clinical interventions made by the pharmacist, 37patients (37/61:61%) and 36 patients (36/68:53%) had an improvement in HbA1c (mean reduction 0.52%) and LDL-C level (mean reduction 0.25mmol/L) respectively. 38 patients (38/65:58%) had lower systolic BP on clinic attendance (mean reduction 4.32mmHg) and 21 patients (21/36:58%) had improvement in ACR (mean reduction 2.12mg/mmol). The pharmacist-led MMCC contributes to a positive impact on drug compliance and therapeutic outcomes.
