Home Medication Review in Improving Patient Medication Adherence and Minimizing Medication Wastage among Type 2 Diabetes Patients

Abstract

In Malaysia, public primary health care clinic serve as the main entry point for most of the chronic patients including diabetes and hypertension patients. The increasing complexity of patients and their treatment regimens need providers who can manage their medication therapy, drug-related problems and identify adverse drug reactions. Unfortunately with a long interval between patients visit and time constrain during the clinic day, the healthcare providers facing difficulties in providing optimal care to those patients [1]. In most cases, physicians and pharmacists received insufficient information on what medications especially the over-the counter medications that patients take at home [2]. In this context, patients need more contact with the healthcare team rather than a single provider in the primary healthcare [1]. In Malaysia, the role of pharmacists have transformed from dispensing to clinical in helping physician to review patients' medication in the ward. Slowly, the pharmacists' roles have been extended to Medication Therapy Adherence Clinics (MTAC). These MTACs are conducted by pharmacists in collaboration with physicians and other healthcare providers to help patients in improving their quality use of medications. However, during the vulnerable period after discharge from hospital or after the monthly follow up in primary care clinics, medication errors or potential medication errors may be present without the knowledge of the physician. To be able to understand in depth the behavioral of patients taking their medications and the storage condition of the medications at home, a home medication review is needed. Therefore, a non-clinical, randomized trial was carried out in Klinik Kesihatan Bukit Minyak, Seberang Perai from April 2013 until March 2014. Eligible patients were randomized into 2 groups; Usual care (UG) and Home Based Intervention (HBI) by using a coin toss approach. Patients' baseline clinical parameter such as HbA1c, blood pressure, BMI, fasting blood sugar were collected during the recruitment. Each patient in the HBI arm was visited twice at his or her houses. During the first visit, the pharmacist did blood pressure monitoring and assessed patients' adherence to medication by using validated questionnaire [3,4].Patients were interviewed to identify any drug-related problems. Pharmacist rectified the problems and discussed with the physician on the regimen if needed. The storage of patients' medications at the house was also checked. Counseling was given to the patients as well as the caregivers on the disease itself, the proper use of medications and the storage of medications. During the second visit (which is 4-6 weeks after the 1