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HOME MEDICATION REVIEW

Ministry of Health Malaysia

Pharmaceutical Services Division

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM 4th August 2007

The ScenarioThe Scenario



Ministry of Health Malaysia, Pharmaceutical Services Division

Our Routine Services

Dispensing Counseling




The Issues 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.




The Role of Pharmacists

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

The positive impact of pharmacist service on outcome for specific diseases has been demonstrated, such as hypertension, heart failure and anticoagulation therapyBeny 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

Home medication review would allow pharmacist to gain greater insight into patients’ methods of managing their drugsRichard 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.




Pilot Project




States Involved In Early Stage

Kedah Darul Aman (2004) Selangor Darul Ehsan (2005) Negeri Sembilan Darul Khusus (2006) Melaka Bandaraya Bersejarah (2006)




HOME MEDICATION REVIEW




Main Objective

To improve the outcome of pharmacotherapy by Home

Medication Review conducted by Pharmacist




Specific Objective 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







Counseling at Home

Help From Other Healthcare Provider




HOME MEDICATION REVIEWHOME MEDICATION REVIEW

EARLY




Medication Being Stored At Home




Unused MedicationCPA-MPS CONFERENCE 2007



Result From Improper Storage Of Medication At Home




Traditional Herbs That Being Consumed By Patient




Other Findings




Adverse Drug Reaction




Complication of the Disease




Program Schedule




Month Activities

1st Month Patient referred to Pharmacist

2nd Month 1st Visit

3rd Month Doctor appointment

4th Month Part supply medication

5th Month Doctor appointment

6th Month 2nd Visit

7th Month Doctor appointment

8th Month Part supply medication




Patient Selection Patients are being selected by FMS/MO and being reffered

to the pharmacist

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




Assessment Parameters 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




Flow Chart

Refer to Pharmacist

Dispensing & Counseling

Recording

FMS / MO

Pharmacist

Pharmacist

Recruiting Patient

HMR 1/07

HMR 2/07




Flow ChartRemind Patient :

Phone

Visit Patient’s Home

Record all information HMR 3/07

Assess storage of medication at home Counseling

Unsatisfied

Satisfied

Record findings

Send report to DoctorMemo HMR

Pharmacist

Pharmacist

Pharmacist

Pharmacist

Pharmacist

Pharmacist

Home Visit




Flow ChartRegistration

Dispensing & Counseling

Recording

Pharmacist

Pharmacist

Appointment with Doctor / part supply medication

HMR 2/07

Screening

Treatment

Pharmacist

Doctor

Triage Nurses




HMR Form 1

Tarikh

Nama TelDiagnosis Merokok Pengambilan Alkohol Umur Ya : btg/hari Ya :Berat Tidak TidakTinggi Ubat Bukan PreskripsiBangsa Ya Tidak Ya TidakJantina Catatan : Catatan :PekerjaanTahap PendidikanTidak Sek :

Sek. Ren : Lupa ambil ubat

Sek. Men : Lain-lain, sila nyatakan

Uni/Kolej :Catatan :

SendiriBantuanNyatakan

Tarikh Mula DosTarikh Ubah

DosDos

Tarikh Berhenti

Tarikh Mula Semula

Dos

HMR 1/07

HOME MEDICATION REVIEWBAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA

No Rujukan Pesakit

:::

: :

::

::

Kesan Adverse Ubat

Sejarah Pengubatan :

Ubat

*Isi borang ADR & kepilkan salinanJangkamasa menghidap penyakit

Sebab-sebab Ubat Diberhentikan :Sebab-sebab BerhentiUbat

( ) Ya ( ) Tidak

Mengambil ubat

Pernahkah mendapat kaunseling dari pegaw ai farmasi?

Faktor Ketidakpatuhan Ubat

::



HMR Form 2

Tarikh

2. Parameter Dikaji

Dos (D)Selang

masa (F)Indikasi ( I )

Cara P engambilan

(T)Skor Parameter Bacaan

Julat / Bacaan Normal

TarikhFBSRBS (P2)HbA1cUrine AlbSr CrClBPPulseTCTG

Ya (0) Tidak (1) Skor

Tandakan

Kuantiti P erlu diambil (A)

Lebihan Didispen (B)

Baki Didapati (c)

Perbezaan (D=C - B)

(A-D)/A %

Baik (DFIT = 100%)

Baik (>11markah MAS)Tidak (<11markah MAS)Baik (> 80%)Tidak (< 80%)

Nota Peg FarmasiKefahaman DFIT pesakit

Lain-Lain :

3. Kajiselidik Kepatuhan Ubat Pesakit (Medication Adherence Scale 'MAS')* Betul : 1 Salah : 0 [Jumlah (%)]

8)Kesukaran mengingat cara pengambilan ubat (rawatan)

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 ?

No Ruj Pesakit

HOME MEDICATION REVIEWBAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA

HMR 2/07

Ubat-ubatan

1. Kajiselidik Kefahaman Pesakit *

4. Kajiselidik Kepatuhan Ubat Pesakit (Pill Count)

CatatanUbat-ubatan

(Skor 11-12 Patuh pada rawatan ubat ; Skor 1-10 Tidak patuh pada rawatan ubat) JUMLAH SKOR

c) Kadang-kala (3 markah) cth : tertidur / melengahkan dll d) Selalu (2 markah) cth : nyanyuk / berkaitan penyakit kognitif dll

a) Tidak pernah / jarang sekali (5 markah)

e) Tidak mengambil ubat (1 markah) cth : kerana tidak boleh toleransi kesan samping

b) Ada masa-masa tertentu (4 markah) cth : kenduri / ke rumah anak dll

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 ?

Cadangan Intervensi PengubatanPiawai Kepatuhan Ubat adalah > 80%

Tidak (DFIT < 100%)

Kepatuhan Ubat Pesakit



HMR Form 3

Kuantiti Kos

Kuantiti Kuantiti

No Rujukan Pesakit

MASA BERAKHIR LAWATAN OLEH

HMR 3/07BORANG HOME MEDICATION REVIEW

BAHAGIAN PERKHIDMATAN FARMASI KEMENTERIAN KESIHATAN MALAYSIA

Makan Tengahari

Informasi Diet

Minum pagi

Jenis

Makan Malam :

Aktiviti Harian

‘Medication Box’

Overstocking

Minuman

Cahaya (L)Kelembapan

dan Haba (M)

2. INFORMASI DIET DAN AKTIVITI HARIAN

1. CARA SIMPANAN UBAT-UBATANBekas kedap udara/ tertutup

Nama (N)Tarikh

Luput (E)

Simpan jauh daripada

Kanak-kanak ( C )

Nama ubat

Jumlah skor

Bil

Label Ubat

TARIKH LAWATAN MASA MULA

Minum Malam :

Sarapan:

1. Adakah ubat yang anda simpan mempunyai label 'nama ubat' ? 2. Adakah ubat yang anda simpan mempunyai label tarikh luput? 3. Adakah ubat yang anda simpan dijauhkan dari kanak-kanak? 4. Adakah ubat yang anda simpan dijauhkan dari cahaya? 5. Adakah ubat y

Jenis

Minum petang :

Makanan

CATATAN (Jika ada)



Appointment With Doctor / Part Supply Medication




The Interventions 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




The Interventions 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




HOME MEDICATION REVIEWHOME MEDICATION REVIEW




Storage Of Medication At Home




Cost Saving Cost saving data based on unused medication at

home (Selangor data : 20 patient)

Patient RM6 322.414 449.87

PKD Petaling 4 33.204 198.402 79.30

20 1083.18PKD Sepang

Total

PKDPKD Kuala LangatPKD Klang

PKD Sabak Bernam




Outcome of HMR 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




Outcome of HMR

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




Future Plan 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




Future Plan Proper training to conduct HMR

– Clinical pharmacy– Counseling

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.




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)




Thank You

Prepared by:

Mohd Dziehan Mustapa Pharmacist U41

Pharmaceutical Services DivisionHealth Department Of Selangor

(PKD Kuala Langat)



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