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HOME MEDICATION REVIEW Ministry of Health Malaysia Pharmaceutical Services Division CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007.

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Presentation on theme: "HOME MEDICATION REVIEW Ministry of Health Malaysia Pharmaceutical Services Division CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007."— Presentation transcript:

1 HOME MEDICATION REVIEW Ministry of Health Malaysia Pharmaceutical Services Division CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007

2 The Scenario CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

3 Our Routine Services DispensingCounseling CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

4 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

5 The Issues n Patients come to doctor’s appointment with progressing complication of the disease. n Patient has repeated admission to hospital due to disease progression n What happened with medication that we dispensed?No respond towards the drug? n Geriatrics with multiple medication. n Most of the patients actually don’t understand how to take their medication correctly as prescribed. CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

6 The Role of Pharmacists n 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, Oxford, UK n 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, Oxford, UK n 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 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

7 Pilot Project CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

8 States Involved In Early Stage n Kedah Darul Aman (2004) n Selangor Darul Ehsan (2005) n Negeri Sembilan Darul Khusus (2006) n Melaka Bandaraya Bersejarah (2006) CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

9 HOME MEDICATION REVIEW CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

10 Main Objective To improve the outcome of pharmacotherapy by Home Medication Review conducted by Pharmacist CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

11 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 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

12 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

13 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division Counseling at Home

14 Help From Other Healthcare Provider CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

15 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

16 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

17 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

18 HOME MEDICATION REVIEW EARLY CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

19 Medication Being Stored At Home CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

20 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

21 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

22 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

23 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

24 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

25 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

26 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

27 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

28 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

29 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

30 Unused Medication CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

31 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

32 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

33 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

34 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

35 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

36 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

37 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

38 Result From Improper Storage Of Medication At Home CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

39 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

40 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

41 Traditional Herbs That Being Consumed By Patient CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

42 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

43 Other Findings CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

44 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

45 Adverse Drug Reaction CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

46 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

47 Complication of the Disease CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

48 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007

49 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

50 Program Schedule CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

51 MonthActivities 1 st Month Patient referred to Pharmacist 2 nd Month 1 st Visit 3 rd Month Doctor appointment 4 th Month Part supply medication 5 th Month Doctor appointment 6 th Month 2 nd Visit 7 th Month Doctor appointment 8 th Month Part supply medication CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

52 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 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

53 Assessment Parameters n Medication knowledge n Medication compliance n Laboratory indices –Blood Glucose Level (FBS, RBS / 2HPP) –Urine protein –Serum Creatinine –Blood pressure (BP) –Lipid profile (Kolesterol & TG) –BMI (Body Mass Index) n Quality of Life n Storage of medication at home. n Cost saving (unused medication) n Intervention done CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

54 Flow Chart Refer to Pharmacist Dispensing & Counseling Recording FMS / MO Pharmacist Recruiting Patient HMR 1/07 HMR 2/07 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

55 Flow Chart Remind 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 Doctor Memo HMR Pharmacist Home Visit CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

56 Flow Chart Registration Dispensing & Counseling Recording Pharmacist Appointment with Doctor / part supply medication HMR 2/07 Screening Treatment Pharmacist Doctor Triage Nurses CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

57 HMR Form 1 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007

58 HMR Form 2 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007

59 HMR Form 3 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007

60 Appointment With Doctor / Part Supply Medication CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

61 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007

62 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

63 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007

64 The Interventions n Method of proper storage of medication at home n Patient knowledge on medication (dispensing and follow up counseling) n Report any findings of ADR n Advice on proper diet and daily activities CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

65 The Interventions n 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 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

66 HOME MEDICATION REVIEW CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

67 Storage Of Medication At Home CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

68 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

69 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

70 Cost Saving n Cost saving data based on unused medication at home (Selangor data : 20 patient) CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

71 Outcome of HMR n Improvement of treatment outcome. n Reduce incident of unscheduled appointment n Reduce repeated admission to hospital emergency dept due to disease progression / complication. n Reduce cost due to wastage of unused medication at home. n Increase patient empowerment to manage their disease at home more effectively. n Improve patient’s Quality Of Life CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

72 Outcome of HMR n Reduce cost on treatment for disease complication in future. n Improve patient’s perception towards the service provided by MOH n Involvement of pharmacist at healthcare centre in Clinical Pharmacy activity n Bring new image of pharmacy services at healthcare center n Recognition & motivation for pharmacy career & development CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

73 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

74 Future Plan n HMR can be done by all healthcare centers throughout Malaysia. n Put up designated posts of Pharmacist to conduct HMR dedicatedly. n No age limit and covers : –Psychiatric patients –Patient that being prescribed with narrow therapeutic index medication (e.g. Epilepsy patients) –Uncontrolled asthmatic patients CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

75 Future Plan n Proper training to conduct HMR –Clinical pharmacy –Counseling n Standard Operating Procedure. n Conduct multi-centre study in order to evaluate whether the delivery HMR by pharmacist are cost effective in improving treatment outcomes for patients. CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007 Ministry of Health Malaysia, Pharmaceutical Services Division

76 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 CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007

77 Thank You Prepared by: Mohd Dziehan Mustapa Pharmacist U41 Pharmaceutical Services Division Health Department Of Selangor (PKD Kuala Langat) CPA-MPS CONFERENCE 2007 MEDICATION REVIEW SYMPOSIUM 4 th August 2007


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