Authors (including presenting author) :
Lee CF(1), Chu LM(1), Young WM(1), Wong KT(1), Mok CK(2)
Affiliation :
(1)Department of Pharmacy, Tuen Mun Hospital
(2)Department of Medicine and Geriatrics, Tuen Mun Hospital
Introduction :
Since December 2017, Drug Refill Service (DRS) has been implemented in Tuen Mun Hospital targeting patients with prolonged follow-up in medical and geriatric specialist out-patient clinic (SOPC). Non-compliance is a common drug-related problem encountered by DRS pharmacist. Between patient’s SOPC appointments, pharmacist reconciles medication for each case and phones patients with medication changes. Despite repeated compliance re-enforcement under the current out-patient service model, non-compliance problem usually persists. Hence, a two-tier follow-up system for non-compliance case was established to improve the situation.
Objectives :
To enhance medical care through active pharmacist drug compliance review and intervention between each SOPC appointment.
Methodology :
Patients who were suspected to be non-compliant to at least one medication upon tele-pharmacist consultation were referred to face-to-face pharmacist consultation for pills count, compliance reinforcement and expiry date check of home stock. Detailed counseling would be offered to rectify any non-compliance problem. Underlying causes of non-compliance were also investigated and documented in Clinical Management System (CMS). Patient would be followed-up by pharmacist 4 weeks later via tele-pharmacist consultation again, or another face-to-face consultation if necessary. If non-compliance persists, pharmacist will inform the prescribing doctor with recommendations.
Non-compliance cases with first face-to-face pharmacist consultation between 1/6/2020-30/11/2020 were included in the review. Case details were retrieved from Pharmacy Management System and electronic Patient Records.
Result & Outcome :
A total of 37 suspected-non-compliance cases were handled. Chronic medications including blood pressure medications (15), oral antidiabetics (6), anticoagulants (1) and antiplatelets (3) were commonly involved. Compliance was confirmed in 4 cases. 33 cases were counseled by face-to-face consultation. Post-intervention review: one case failed to reach subsequently; compliance was achieved in 26 cases (78.8%); remaining 6 (21.2%) cases were referred to prescriber for drug regimen review - one case pending review by prescriber; 4 (80%) recommendations from pharmacist including streamlining of drug regimen and review of drug use were accepted; one recommendation was not accepted as patient opted to continue current regimen after prescriber’s review.
Through the combination of face-to-face assessment with subsequent tele-pharmacist consultation, pharmacist could successfully resolve 96.8% non-compliance problems as encountered in the DRS medication reconciliation. This two-tier system becomes the standard of care for DRS non-compliant patients now.
