Effectiveness of pharmacist home health care for tupe 2 diabetes in Bangkok metropolitan : a community based study

Abstract

Background: The diabetes was common chronic disease in Thailand with increasing burdens of morbidity and mortality. There were 42.8% of diabetes patients in Bangkok who had been treated but disease conditions were uncontrolled. The diabetes was associated with metabolic risk of co-morbidities and treated with polypharmacy. Consequently, diabetes with the drug related problems (DRPs) frequently occur, leading to problems on disease controlled. The objective of this study was to assess the effectiveness of community pharmacist home health care for diabetic patients in community-based Bangkok Metropolis. The community pharmacists were required to indentify the drug related problems of diabetes by using medication therapy management (MTM) as the service template. Methods: This study was an action research using one group before-and-after. The Thirty-four communities out of 68 Bangkok Metropolitan Health Centers were participating in referring uncontrolled diabetic patients to 3 community pharmacy settings for home health care visits. The study populations were 288 uncontrolled diabetic patients with high prevalence of drug related problems were purposively identified by nurses from primary care units during their regular home health visits and referred to community pharmacists. Three pharmacist home health care interventions using MTM services were planned over the 6-month period. Two additional pharmacist home visits were also conducted for outcome assessment. The average time spent by the pharmacist on each patient was approximately 60 minutes of which 20 minutes were spent on patient and/or caregiver interview and medication review and 40 minutes on intervention, patient medication record, documentation, and referral if needed. Results: The mean (SD) age of 288 patients was 66.0 (9.4) years and 75.3% were female of 288 patients. Hypertension was the main co-morbidity found in 81.7% of patients, and 90% with two or more diseases. They were taking on the average (SD) of 7.1 (3) medications and 89.3% of patients had 4 or more medications. A total of 858 drug related problems or 2.98 problems per patient were identified by registered community pharmacist. Among these, 822 or 95% were non-adherence. The peripheral neuropathy was the major clinical symptoms detected in 134 of patients. Inappropriate eating behavior and lack of exercise were life- style problems. After 3 interventions, non-adherence level was changed to adherent level and partial adherent by 18.2%, 26%, respectively. Fasting blood glucose level > 126 mg/dL was improved in 3.38% of patients, while blood pressure level was improved in 56.1% of patients by changing from hypertension stage II to lower stage. Out of 34 cases referred to physicians, 55% or 19 cases had their medications altered as recommended by community pharmacists. Conclusion: This study concluded that community pharmacist home health care could alleviate patients' medication utilization problems and would thus improve overall quality of patient care. The integrated care among primary care units and community pharmacists would be recommended to extend to other provinces and at a larger scale. Policy: Community pharmacy services have not been a part of universal health coverage. However, Medication Therapy Management (MTM) for chronic conditions provided by pharmacists, cover improve quality of patient medication utilization, and they should be included as a part of benefit package for patients. Integrating community pharmacy services as a part of health benefit scheme would improve patient medication utilization and in turn improving patient outcomes.