Drug-Related Problems Identified at Patients' Home: A Prospective Observational Study in a Rural Area of Thailand

Impact of medication therapy management (MTM) service model on multi-morbidity (MMD) patients with hypertension: a pilot RCT

BACKGROUND

This study explored the impact of MTM service on MMD patients with hypertension.

METHODS

A total of 120 MMD inpatients from September to November 2019 were received and randomly divided into intervention group and control group. General services for noninfectious chronic diseases were given to the control group, while a standard MTM service was given to the intervention group. Patients' blood pressure, EQ-5D utility value, readmission rate, drug-related problems, and average daily medication therapy cost were compared between the two groups and within the groups. This was done at the initial admission phase and in the first, third, sixth, and twelfth months after discharge.

RESULTS

The intervention group had significantly lower blood pressure and average daily medication therapy cost 12 months after discharge compared to the control group (systolic blood pressure: P = 0.023, diastolic blood pressure: P < 0.001, average daily medication therapy cost: P = 0.049); the number of DRPs decreased in both groups 12 months after discharge; the number of DRPs solved in the intervention group in the third, sixth and twelfth months after discharge were statistically higher compared with that in the control group (P = 0.013, P = 0.012, P = 0.001); there was no significant difference in the EQ-5D utility value and readmission rate between the two groups (P > 0.05).

CONCLUSIONS

MTM implementation in MMD patients can improve health outcomes and reduce healthcare-related costs among MMD patients.

TRIAL REGISTRATION

Chinese Clinical Trial Register ChiCTR2200065111, date of registration: October 28, 2022.

Effects of home drug delivery on drug-related problems: preliminary evidence for improved patient outcomes during the COVID-19 pandemic in Thailand

Background

Drug-related problems cause severe disabilities, premature deaths, and unnecessary costs. Telepharmacy offer easier access to needed medications, preventing DRPs. Adoption has been slow, and it is unclear what aspects of telepharmacy are most important. The COVID-19 pandemic disrupted health services, forcing the rapid adoption of telepharmacy. In Phayao, Thailand, a program was implemented for home delivery of drugs for patients with chronic disease.

Objectives

This study aimed to explore the prevalence and factors associated with DRPs of patients with chronic disease who received home drug-delivery services.

Methods

A cross-sectional study was undertaken in Phayao Province located in North Thailand. Simple random sampling was used to select patients from 6 public hospitals between July and August 2020. Logistic regression was used to analyze multivariate factors that might be related to DRPs.

Results

A total of 246 participants reported at least 1 DRP (49.30%). Most participants were female (58.32%) with elementary education (60.72%). Their mean age was 63.69 (SD = 12.97) years. The 5 most common DRPs were changes of drug packaging or drug brands (18.84%), leftover medications of more than 2 weeks (18.44%), nonadherence (17.43%), having conditions or diseases requiring additional medications (6.81%), and adverse drug reactions (5.21%). Univariate analysis identified number of chronic conditions, diabetes mellitus, dyslipidemia, chronic kidney disease, education level, and drug-delivery channel as predictors of DRPs. In multivariate analysis, predictors of DRPs were the number of drugs used per day (adjusted odds ratio [aOR] 1.11 [95% CI 1.03-1.19], P = 0.004) and dyslipidemia (aOR 1.83 [95% CI 1.18-2.84], P = 0.007). Nonadherence was associated with leftover medicines (aOR 4.22 [95% CI 2.44-7.28], P < 0.001)

Conclusion

The present results indicate that home delivery caused no increase and may have caused a decrease in DRPs, and patients were highly satisfied. These promising results suggest that home delivery should be continued and further investigated even as the COVID-19–induced emergency subsides.

Public Perceptions About Home Delivery of Medication Service and Factors Associated with the Utilization of This Service

INTRODUCTION

Home medication delivery service is a major service for the public. It reduces overcrowding and unnecessary visits to health centers. This study aims to investigate the public perception of home delivery of medication service in Jordan and evaluate factors affecting the use of this service.

METHODS

The study was conducted in March 2022 using an online survey. Participants were asked to fill out a validated questionnaire to evaluate their perception of home delivery of medication service.

RESULTS

Among the 1032 adult participated in this study, the majority reported that they had heard of home delivery of medication service (n = 832, 80.6%). However, only 30.9% of them have used this service before. Results showed that 71.4% of the participants (n = 737) believe that home delivery of medication service is more convenient and accessible than in-store drug refill. In addition, 65.6% of the participants (n = 677) believed that home delivery of medication service is suitable only for refill-prescription drugs (65.0%). The main pros of the service as perceived by the study participants were to serve sick patients, elderly, and disabled people (n = 822, 79.7%). In contrast, the inability of patients to build a professional relationship with pharmacists using home delivery of medications service was the most perceived con of this service (n = 627, 60.8%). Finally, regression analysis revealed that older participants, those with chronic diseases, and those who visit community pharmacies two times or more per month revealed higher use of the service (P = <0.05).

CONCLUSION

This study has shown that most participants showed positive perceptions toward the home delivery of medication services. However, participants believed that this service may decrease pharmacist's patient contact time, thus affecting the quality of medication counseling. More comprehensive future studies are necessary to examine the financial aspects of such a service and its associated drawbacks.

Prevalence and Associated Factors of Drug-Related Problems Among Older People: A Cross-Sectional Study at King Chulalongkorn Memorial Hospital in Bangkok

BACKGROUND AND OBJECTIVE

The use of multiple medications and altered pharmacokinetics/pharmacodynamics may lead to drug-related problems in members of the older population. The aim of this study is to evaluate the prevalence of, and factors related to, drug-related problems in older urban-living Thai people.

METHODS

We conducted a cross-sectional study involving 466 participants (aged ≥ 65 years) whose first-time health screening at the Geriatric Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok was between May and October 2019. Participants were interviewed and assessed for drug-related problems by clinical pharmacists.

RESULTS

In total, 54.5% (254) of the participants were aged 65-69 years and 77.0% (359) of the participants were women. Of the participants, 56.7% had three or more health conditions such as hyperlipidemia (62%), hypertension (46%), and cataract (18%). Fifty-five percent of the participants took five or more health products (polypharmacy) and 16% took ten or more products on a regular basis. Of the 2633 products used, 68% were prescription drugs and 32% were over-the-counter products. The prevalence of drug-related problems according to the criteria suggested by Cipolle-Strand-Morley (2012) was 63.3% (587 drug-related problems). Most of the problems came from: (a) non-adherence (28.6%); (b) needs for additional drug therapy (26.4%); and (c) adverse drug reactions (17.4%). Factors associated with drug-related problems were polypharmacy (odds ratio 2.50, 95% confidence interval 1.60-3.89) and multiple comorbidities [three or more conditions] (odds ratio 2.20, 95% confidence interval 1.41-3.43).

CONCLUSIONS

The prevalence of drug-related problems in urban-living older people at King Chulalongkorn Memorial Hospital in Bangkok was high. Polypharmacy and multiple comorbidities were significantly related to drug-related problems. To decrease the number of drug-related problems, pharmacists should collaborate with healthcare teams and suggest how to correctly reduce the number of health products being consumed by older people.