Transcript Pharmacist Home Care Service

CPA-MPS CONFERENCE 2007
MEDICATION REVIEW SYMPOSIUM 4th August 2007
HOME MEDICATION REVIEW
Ministry of Health Malaysia
Pharmaceutical Services Division
CPA-MPS CONFERENCE 2007
MEDICATION REVIEW SYMPOSIUM 4th August 2007
The Scenario
Ministry of Health Malaysia, Pharmaceutical Services Division
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
Our Routine Services
Dispensing
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Counseling
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
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The Issues
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Patients come to doctor’s appointment with
progressing complication of the disease.
Patient has repeated admission to hospital due to
disease progression
What happened with medication that we
dispensed?No respond towards the drug?
Geriatrics with multiple medication.
Most of the patients actually don’t understand how
to take their medication correctly as prescribed.
Ministry of Health Malaysia, Pharmaceutical Services Division
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The Role of Pharmacists
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Pharmacist is in an ideal position to assist with
medication-related problems.
Beny J, Bero LA, Bond C. Expending role of outpatient pharmacist: effect on health services utilization,
cost and patient outcomes (Cochrane Review). In: The Cochrane Library, Issue 3, 2000. Oxford, UK
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The positive impact of pharmacist service on outcome
for specific diseases has been demonstrated, such as
hypertension, heart failure and anticoagulation therapy
Beny J, Bero LA, Bond C. Expending role of outpatient pharmacist: effect on health services utilization, cost and patient
outcomes (Cochrane Review). In: The Cochrane Library, Issue 3, 2000. Oxford, UK
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Home medication review would allow pharmacist to
gain greater insight into patients’ methods of managing
their drugs
Richard Holland, Elizabeth Lenagham, Ian Harvey, Richard Smith. Does home based medication review keep older
people out of hospital? The HOMER randomized controlled trial. BMJ 2005.
Ministry of Health Malaysia, Pharmaceutical Services Division
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Pilot Project
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States Involved In Early Stage
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Kedah Darul Aman (2004)
Selangor Darul Ehsan (2005)
Negeri Sembilan Darul Khusus (2006)
Melaka Bandaraya Bersejarah (2006)
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HOME MEDICATION
REVIEW
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Main Objective
To improve the outcome of
pharmacotherapy by Home
Medication Review conducted by
Pharmacist
Ministry of Health Malaysia, Pharmaceutical Services Division
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Specific Objective
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To increase patients’ adherence to medication
To increase patients’ knowledge on medication (dosing
frequency, indication & administration (DFIT)
To identify factors affecting non-compliance
To review patient’s method of managing their medication
at home
To identify drug related problems
To reduce wastage due to over-stocking of medication
To improve patient’s Quality of Life
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Counseling at Home
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Help From Other Healthcare Provider
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EARLY
HOME MEDICATION REVIEW
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Medication Being Stored At Home
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
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CPA-MPS CONFERENCE 2007
MEDICATION REVIEW SYMPOSIUM 4th August 2007
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
Ministry of Health Malaysia, Pharmaceutical Services Division
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
Ministry of Health Malaysia, Pharmaceutical Services Division
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
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Unused Medication
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Ministry of Health Malaysia, Pharmaceutical Services Division
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
Ministry of Health Malaysia, Pharmaceutical Services Division
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
Ministry of Health Malaysia, Pharmaceutical Services Division
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Result From Improper Storage Of
Medication At Home
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Traditional Herbs That Being
Consumed By Patient
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Other Findings
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Adverse Drug Reaction
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Complication of the Disease
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Program Schedule
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Month
1st Month
2nd Month
3rd Month
4th Month
5th Month
6th Month
7th Month
8th Month
Activities
Patient referred to Pharmacist
1st Visit
Doctor appointment
Part supply medication
Doctor appointment
2nd Visit
Doctor appointment
Part supply medication
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Patient Selection
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Patients are being selected by FMS/MO and being reffered
to the pharmacist
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Inclusion Criteria :
 Patients who have problems with medication compliance which
leads to disease complication.
This include:
 Patients who have more than 1 chronic disease and being
prescribed with 5 or more medication for maintenance therapy.
 Geriatric patients with chronic disease with no caregiver to
participate/assist in patient medication treatment
 Psychiatric patients
 Patients who still have poor technique of medical aid device
(MDIs, insulin syringes) despite counseling
Ministry of Health Malaysia, Pharmaceutical Services Division
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Assessment Parameters
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Medication knowledge
Medication compliance
Laboratory indices
– Blood Glucose Level (FBS, RBS / 2HPP)
– Urine protein
– Serum Creatinine
– Blood pressure (BP)
– Lipid profile (Kolesterol & TG)
– BMI (Body Mass Index)
Quality of Life
Storage of medication at home.
Cost saving (unused medication)
Intervention done
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Flow Chart
Recruiting Patient
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Refer to
Pharmacist
Dispensing &
Counseling
HMR 1/07
Recording
HMR 2/07
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FMS / MO
Pharmacist
Pharmacist
Flow Chart
Home Visit
HMR 3/07
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Remind Patient :
Phone
Pharmacist
Visit Patient’s Home
Pharmacist
Record all information
Pharmacist
Assess storage of
medication at home
Pharmacist
Unsatisfied
Counseling
Satisfied
Memo HMR
Record findings
Pharmacist
Send report
to Doctor
Pharmacist
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Flow Chart
Appointment with
Doctor /
part supply
medication
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Registration
Triage
Screening
Treatment
Dispensing & Counseling
HMR 2/07
Recording
Ministry of Health Malaysia, Pharmaceutical Services Division
Nurses
Pharmacist
Doctor
Pharmacist
Pharmacist
No Rujukan Pesakit
Tarikh
HMR 1/07
HOME MEDICATION REVIEW
BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA
Nama
:
Diagnosis :
Umur
:
Berat
:
Tinggi
:
Bangsa
:
Jantina
:
Pekerjaan :
Tahap Pendidikan
Tidak Sek :
Tel
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Merokok
Ya :
btg/hari
Tidak
Ubat Bukan Preskripsi
Ya
Tidak
Catatan :
:
Pengambilan Alkohol
Ya :
Tidak
Kesan Adverse Ubat
Ya
Tidak
Catatan
:
Jangkamasa menghidap penyakit
*Isi borang ADR & kepilkan salinan
Faktor Ketidakpatuhan Ubat
Pernahkah mendapat kaunseling dari
pegaw ai farmasi?
Sek. Ren :
Sek. Men :
Uni/Kolej :
Mengambil ubat
Sendiri
:
Bantuan
:
Nyatakan
(
) Ya (
Lupa ambil ubat
Lain-lain, sila nyatakan
) Tidak
Catatan :
Sejarah Pengubatan :
Ubat
Tarikh Mula
Dos
Tarikh Ubah
Dos
Sebab-sebab Ubat Diberhentikan :
Ubat
Sebab-sebab Berhenti
Dos
Tarikh
Berhenti
Tarikh Mula
Semula
Dos
HMR Form 1
No Ruj Pesakit
Tarikh
HMR 2/07
HOME MEDICATION REVIEW
BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA
1. Kajiselidik Kefahaman Pesakit *
Ubat-ubatan
Dos (D)
Selang
masa (F)
Indikasi ( I )
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2. Parameter Dikaji
Cara
P engambilan
(T)
Skor
Parameter
Bacaan
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Julat /
Bacaan
Normal
Tarikh
FBS
RBS (P2)
HbA1c
Urine Alb
Sr CrCl
BP
Pulse
TC
TG
* Betul : 1 Salah : 0 [Jumlah (%)]
3. Kajiselidik Kepatuhan Ubat Pesakit (Medication Adherence Scale 'MAS')
Ya (0) Tidak (1)
1)Pernahkah anda lupa mengambil ubat anda ?
2)Dalam tempoh 2 minggu kebelakangan ini, pernahkah anda terlupa mengambil ubat?
3)Pernahkan anda mengurangkan dos anda sendiri tanpa pengetahuan doktor ?
4)Pernahkah anda terlupa membawa ubat anda semasa anda pergi bercuti ?
5)Adakah anda mengambil ubat anda semalam ?
6)Pernahkah anda berhenti pengambilan ubat apabila anda rasa anda telah sihat ?
7)Pernahkah anda rasa rawatan ini menyusahkan ?
8)Kesukaran mengingat cara pengambilan ubat (rawatan)
Tandakan
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a) Tidak pernah / jarang sekali (5 markah)
b) Ada masa-masa tertentu (4 markah) cth : kenduri / ke rumah anak dll
c) Kadang-kala (3 markah) cth : tertidur / melengahkan dll
d) Selalu (2 markah) cth : nyanyuk / berkaitan penyakit kognitif dll
e) Tidak mengambil ubat (1 markah) cth : kerana tidak boleh toleransi kesan samping
(Skor 11-12 Patuh pada rawatan ubat ; Skor 1-10 Tidak patuh pada rawatan ubat) JUMLAH SKOR
4. Kajiselidik Kepatuhan Ubat Pesakit (Pill Count)
Ubat-ubatan
Kuantiti P erlu
diambil (A )
Lebihan
Baki
Didispen (B) Didapati (c)
Perbezaan
(D=C - B)
Skor
Catatan
(A-D)/A %
Nota Peg Farmasi
Kefahaman DFIT pesak it
Baik (DFIT = 100%)
Tidak (DFIT < 100%)
Kepatuhan Ubat Pesak it
Baik (>11markah MAS)
Tidak (<11markah MAS)
Baik (> 80%)
Tidak (< 80%)
Lain-Lain :
Piawai Kepatuhan Ubat adalah > 80%
Cadangan Intervensi Pengubatan
HMR Form 2
No Rujukan Pesakit
HMR 3/07
BORANG HOME MEDICATION REVIEW
BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA
TARIKH LAWATAN
MASA MULA
1. CARA SIMPANAN UBAT-UBATAN
Label Ubat
Bil
Nama ubat
Nama (N)
MASA BERAKHIR
Simpan jauh daripada
Kanakkanak
(C)
Tarikh
Luput (E)
Kelembapan
Cahaya (L) dan Haba
(M )
LAWATAN OLEH
Overstocking
Kuantiti
Kos
Bekas
kedap
udara/
tertutup
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‘Medication
Box’
Jumlah skor
1. A dakah ubat yang anda simpan mempunyai label 'nama ubat' ? 2. A dakah ubat yang anda simpan mempunyai label tarikh luput? 3. A dakah ubat yang anda
simpan dijauhkan dari kanak-kanak? 4. A dakah ubat yang anda simpan dijauhkan dari cahaya? 5. A dakah ubat y
2. INFORMASI DIET DAN AKTIVITI HARIAN
Informasi Diet
Makanan
Jenis
Sarapan:
Minum
pagi
Makan
Tengahari
Minum
petang :
Makan
Malam :
Minum
Malam :
CATATAN (Jika ada)
Kuantiti
Minuman
Jenis
Aktiviti Harian
Kuantiti
HMR Form 3
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Appointment With Doctor / Part
Supply Medication
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The Interventions
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Method of proper storage of medication at
home
Patient knowledge on medication (dispensing
and follow up counseling)
Report any findings of ADR
Advice on proper diet and daily activities
Ministry of Health Malaysia, Pharmaceutical Services Division
CPA-MPS CONFERENCE 2007
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The Interventions
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Intervention towards improving
pharmacotherapy
– Increase, reduce or maintain the dose
– Add, combine or withdrawal of medication
being prescribed
– Increase or decrease dosing frequency
(improve patient’s compliance)
– Improve technique
Ministry of Health Malaysia, Pharmaceutical Services Division
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Storage Of Medication At Home
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Cost Saving
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Cost saving data based on unused medication at
home (Selangor data : 20 patient)
PKD
PKD Kuala Langat
PKD Klang
PKD Petaling
PKD Sabak Bernam
PKD Sepang
Total
Patient
6
4
4
4
2
20
Ministry of Health Malaysia, Pharmaceutical Services Division
RM
322.41
449.87
33.20
198.40
79.30
1083.18
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Outcome of HMR
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Improvement of treatment outcome.
Reduce incident of unscheduled appointment
Reduce repeated admission to hospital
emergency dept due to disease progression /
complication.
Reduce cost due to wastage of unused
medication at home.
Increase patient empowerment to manage their
disease at home more effectively.
Improve patient’s Quality Of Life
Ministry of Health Malaysia, Pharmaceutical Services Division
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Outcome of HMR
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Reduce cost on treatment for disease
complication in future.
Improve patient’s perception towards the service
provided by MOH
Involvement of pharmacist at healthcare centre in
Clinical Pharmacy activity
Bring new image of pharmacy services at
healthcare center
Recognition & motivation for pharmacy career &
development
Ministry of Health Malaysia, Pharmaceutical Services Division
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MEDICATION REVIEW SYMPOSIUM 4th August 2007
Ministry of Health Malaysia, Pharmaceutical Services Division
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Future Plan
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HMR can be done by all healthcare centers
throughout Malaysia.
Put up designated posts of Pharmacist to
conduct HMR dedicatedly.
No age limit and covers :
– Psychiatric patients
– Patient that being prescribed with narrow
therapeutic index medication (e.g. Epilepsy
patients)
– Uncontrolled asthmatic patients
Ministry of Health Malaysia, Pharmaceutical Services Division
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Future Plan
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Proper training to conduct HMR
– Clinical pharmacy
– Counseling
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Standard Operating Procedure.
Conduct multi-centre study in order to
evaluate whether the delivery HMR by
pharmacist are cost effective in improving
treatment outcomes for patients.
Ministry of Health Malaysia, Pharmaceutical Services Division
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Acknowledgement
Dr Lian Lu Ming (Ex-Deputy State Director Of Health Selangor)
Pn Zawiyah Mat Johor (Ex-Assistant Deputy Director Of Health Selangor: Pharmaceuticalcare)
Dr Salmah Bahari (Deputy State Director Of Health Melaka)
Hjh Hazimah Othman (Deputy State Director of Health Negeri Sembilan)
Dr Ramli Abd Ghani (Ex-Deputy Director Of Health Kedah)
Dr Mohamed Azmi Hassali (Lecturer-School of pharmaceutical sciences USM)
Prof Madya Dr Rosnani Hashim (Head of Pharmacy Dept, UKM)
Cik Sameerah Bt Shaikh Abdul Rahman (Deputy Assistant Director Of Pharmacy KKM)
Pn Norharlina Sulaiman (Assistant Director Pharmaceutical Care Service Division Selangor)
Nor Azlina Sariam(Pharmacist PKD Klang)
Norhanizah Hashim(Pharmacist PKD Petaling)
Farahwahida Mohd Kassim (Pharmacist PKD Petaling)
Kobu Thiruvanackan(Ex-Pharmacist PKD Sabak Bernam)
Srima Elina Shamsuri(Ex-Pharmacist PKD Sepang)
Zaitulhusna Md Safee(Ex-Pharmacist PKD Hulu Langat)
Pn Azwana Supian (Pharmacist PKD Seremban)
Ministry of Health Malaysia, Pharmaceutical Services Division
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Thank You
Prepared by:
Mohd Dziehan Mustapa
Pharmacist U41
Pharmaceutical Services Division
Health Department Of Selangor
(PKD Kuala Langat)