Friday, May 15, 2009

Abstract HMR

Improvement in patient medication compliance & treatment outcome through Home Medication Review (HMR) conducted by pharmacist at primary health clinic in State of Selangor

M. Dziehan, Wong Yee Cheat, Kobu a/l Thiruvanackan, Azlina Sariam

1. KK Telok Panglima Garang, PKD Kuala Langat
2. KK Bukit Kuda, PKD Klang
3. KK Kelana Jaya, PKD Petaling
4. KK Sungai Besar, PKD Sabak Bernam


Introduction; Poor medication compliance among chronic disease patient leads to poor treatment outcome although best medication treatment prescribed to them. Based on preliminary study we found that only 41.37% of medication prescribed consume by patient and patient medication knowledge is poor (21.92% DFIT score). Patient treatment outcome is still not achieving the standard Aims; This study conducted to evaluate the impact of Home Medication Review (HMR) by pharmacist toward improvement of patient medication compliance as well as medication knowledge. This study also focuses on improvement toward patient treatment outcome and improvement toward number of drug-related problems identified and number of recommendation of intervention by the pharmacist through HMR program Methods; This is a retrospective and prospective study performed in four health clinics in Selangor where pre remedial and post remedial action taken. Improvement on medication compliance, medication knowledge and treatment outcome were examined. Patient recruited (FMS/MO referred patient based on selection criteria) and the data collected are from August 2006 until April 2007. This program focuses on uncontrolled Diabetes Mellitus and or uncontrolled Hypertension patient which the home visit will be made on the 1st and 5th month. Then final evaluation on patient treatment outcome will be done on the 8th month (final month). In between the visits, assessment on patient understanding and compliance will be conducted at the respective clinic according to the physician appointment date (every 2 months). Result; In post remedial result there is improvement on patient medication compliance base on pill count where the result show 80.21% of medication prescribed consume by patient (standard patient compliance: >80% prescribe medication consume) and patient medication knowledge improve when DFIT score increase to 91.27% (standard patient medication knowledge: 100% score of DFIT). Post remedial action result also show improvement of treatment outcome when there is improvement of BP reading and HbA1c level near to target value. There is 205 finding on drug related problem with 257 recommendation intervention done by pharmacist from this HMR program. Conclusion; This study proves that HMR program conducted at primary health clinic in Selangor as a good preventive program and contribution of clinical knowledge of pharmacist in this program help to improve treatment outcome

Thursday, April 16, 2009

HMR & Wound Care Mangement

From HMR visit done by En Zul last week and last Tuesday, we discover that our DM patient experience Diabetic Ulcer at home. One of the case, the patient get a proper treatment from GP and another case without any treatment at all. In this situation, interesting issue to be discuss is regarding patient awareness on foot care? Do our DM patient aware on important of foot care? Are the patient education regarding foot care done at primary care? This is one of the advantage of HMR., we are not only provide medication review but we are also identify other health related issue to forward the matter to doctors of FMS for further action. Not only that, pharmacist should also educate on basic foot care at home to the patient and care givers. In develop country, the pharmacist are equipped with knowledge on wound care management. They are not just selling product for wound care but they also can give proper advice on which product suitable to the patient. Some of them even deliver service of wound dressing. One of future role of pharmacist at primary health care are on wound care management. We hope that the stakeholder will look forward to do workshop and hand on training on wound dressing especially diabetic ulcer.
Best Regards

Wednesday, April 15, 2009

Wrong Inhaler Technique ; MTAC Respiratory KK Telok Panglima Garang

For 2009, one of the planned activity for Pharmacy PKD Kuala Langat is to start MTAC Respiratory. We hope with this program, pharmacist can contribute an effort toward Asthma management and to help improve poor performance of QA asthma at primary health care. At primary health care, majority of patient with asthma manage and seen by Medical Assistant in clinics which have not enough Doctors or FMS. Due to this situation some of the district fail on management of asthma patient. Pharmacist at Kuala Langat take this wide opportunity to contribute an effort and help other health care professional on management of asthma patient. Now the awareness of lacking attention in asthma management had increased when at least asthma patient now will have doctors appointment one in every six month. With MTAC Respiratory which follows the same concept done at Hospital Melaka will help to improve certain aspects in asthma management especially regarding medication and inhaler technique. For information one of the reason why QA asthma at primary care failed is because of poor inhaler technique usage among patient. I hope with this initiative, pharmacist can help to counsel patient regarding proper inhaler technique and improve quality of life patient by reduce the number of admission to A&E for emergency treatment and to reduce incident of asthma attack at home.

My Best Regards

Tuesday, April 7, 2009

Kuala Langat Unfreeze Back Home Medication Review

Home Medication Review (HMR) started in year 2005 at PKD Kuala Langat. At that time HMR in Selangor focus on uncontrolled DM and HPT patient. The program have been freeze after HMR pilot study review presented to State Health Director of Selangor. Dr Ang request the core team of HMR in Selangor to develop or alter the HMR program so that the element of visiting to patient home been eliminated. Reason for her request is to have a program such as HMR which aim to help and improve patient treatment outcome at clinic level only. So with this approach the number of patient recruited increased. A dedicated HMR team in Selangor gather back and develop new program called 'Medication Therapy Management' (MTM) and still focusing on the same group of patient. MTM started in Selangor June 2007 and a pilot study also been conducted to show an impact of MTM toward patient treatment outcome. These pilot study have been presented in Pharmacy R&D Conference at Hospital Putrajaya last year and won best presenter and runner up in clinical group research. The name of MTM then change to 'Medication Therapy Adherence Counselling' (MTAC) due to standardize the term used all over Malaysia in MOH. Now Clinic Telok Panglima Garang (Pharmacist : Mr Zulkhairy) and Clinic Jenjarom (Pharmacist : Pn Laxmi) in PKD Kuala Langat conducted MTAC program for DM patient and number of patient recruited are about 100 patients for both clinic. Just recently on March 2009 Pharmacy PKD Kuala Langat Unfreeze back the HMR program. Now HMR program in PKD Kuala Langat use Australian version of HMR based on my experience 2 week HMR attachment in Melbourne Australia last year. Currently we are targeting 2-3 visit to patient house each week with complete report and a discussion session with Family Medicine Specialist (FMS) regarding any findings from the visit. HMR now link with MTAC program conducted in both clinic. HMR program have its inclusion criteria and not only for DM patient. HMR can be sub-program for MTAC but HMR also may be suitable to strengthen other program in Public Health (MOH) such as Mental Health and Geriatric Program. We are still learning from experience and hope to hear some comment from other pharmacist or even academician or physician about this program. I will add more information regarding HMR and MTAC program in Kuala Langat in next post soon.
My best regards

Selamat Datang Ke Farmasi PKD Kuala Langat

Selamat datang ke Farmasi PKD Kuala Langat. Blog ini di wujudkan atas landasan untuk berkongsi pengalaman serta perkembangan profesyen farmasi di Kesihatan Awam. Seperti yang semua sedia maklum profesyen farmasi di kesihatan awam masih dalam fasa perkembangan namun pacuannya masih perlahan berbanding profesyen professional lain yang telah lama bertapak kukuh di Kesihatan Awam. Maka di sini kita 'Pharmacist' tidak mahu ketinggalan dalam arus perkembangan kesihatan awam yang deras mengikut perkembangan bidang kesihatan di negara ini.