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

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Home medication review

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

HOME MEDICATION REVIEW

Ministry of Health Malaysia

Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Now

The Scenario

Ministry of Health Malaysia, Pharmaceutical Services Division


Our routine services

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Our Routine Services

Dispensing

Counseling

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


The issues

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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.

Ministry of Health Malaysia, Pharmaceutical Services Division


The role of pharmacists

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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 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

  • 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


Pilot project

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Pilot Project

Ministry of Health Malaysia, Pharmaceutical Services Division


States involved in early stage

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

States Involved In Early Stage

  • Kedah Darul Aman (2004)

  • Selangor Darul Ehsan (2005)

  • Negeri Sembilan Darul Khusus (2006)

  • Melaka Bandaraya Bersejarah (2006)

Ministry of Health Malaysia, Pharmaceutical Services Division


Home medication review1

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

HOME MEDICATION REVIEW

Ministry of Health Malaysia, Pharmaceutical Services Division


Main objective

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Main Objective

To improve the outcome of pharmacotherapy by Home Medication Review conducted by Pharmacist

Ministry of Health Malaysia, Pharmaceutical Services Division


Specific objective

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

During

Home Visit

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Counseling at Home

Ministry of Health Malaysia, Pharmaceutical Services Division


Help from other healthcare provider

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Help From Other Healthcare Provider

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Early

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

EARLY

Findings

HOME MEDICATION REVIEW

Ministry of Health Malaysia, Pharmaceutical Services Division


Medication being stored at home

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Medication Being Stored At Home

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Unused medication

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Unused Medication

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Unused

Medication

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Result from improper storage of medication at home

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Result From Improper Storage Of Medication At Home

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Traditional herbs that being consumed by patient

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Traditional Herbs That Being Consumed By Patient

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Other findings

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Other Findings

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Adverse drug reaction

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Adverse Drug Reaction

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Complication of the disease

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Complication of the Disease

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Program schedule

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Program Schedule

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Patient selection

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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

Ministry of Health Malaysia, Pharmaceutical Services Division


Assessment parameters

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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

Ministry of Health Malaysia, Pharmaceutical Services Division


Flow chart

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Flow Chart

Recruiting Patient

Refer to Pharmacist

FMS / MO

Dispensing & Counseling

Pharmacist

HMR 1/07

HMR 2/07

Recording

Pharmacist

Ministry of Health Malaysia, Pharmaceutical Services Division


Flow chart1

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Flow Chart

Home Visit

Remind Patient : Phone

Pharmacist

Visit Patient’s Home

Pharmacist

HMR 3/07

Pharmacist

Record all information

Pharmacist

Assess storage of medication at home

Counseling

Unsatisfied

Satisfied

Pharmacist

Record findings

Send report to Doctor

Pharmacist

Memo HMR

Ministry of Health Malaysia, Pharmaceutical Services Division


Flow chart2

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Flow Chart

Appointment with Doctor / part supply medication

Registration

Triage

Nurses

Screening

Pharmacist

Treatment

Doctor

Dispensing & Counseling

Pharmacist

Recording

Pharmacist

HMR 2/07

Ministry of Health Malaysia, Pharmaceutical Services Division


Hmr form 1

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

HMR Form 1


Hmr form 2

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

HMR Form 2


Hmr form 3

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

HMR Form 3


Appointment with doctor part supply medication

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Appointment With Doctor / Part Supply Medication

During

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


The interventions

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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

Ministry of Health Malaysia, Pharmaceutical Services Division


The interventions1

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

The Outcome

HOME MEDICATION REVIEW

Ministry of Health Malaysia, Pharmaceutical Services Division


Storage of medication at home

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Storage Of Medication At Home

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Ministry of Health Malaysia, Pharmaceutical Services Division


Cost saving

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Cost Saving

  • Cost saving data based on unused medication at home (Selangor data : 20 patient)

Ministry of Health Malaysia, Pharmaceutical Services Division


Outcome of hmr

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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

Ministry of Health Malaysia, Pharmaceutical Services Division


Outcome of hmr1

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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

Ministry of Health Malaysia, Pharmaceutical Services Division


CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Future

Plan For HMR

Ministry of Health Malaysia, Pharmaceutical Services Division


Future plan

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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

Ministry of Health Malaysia, Pharmaceutical Services Division


Future plan1

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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.

Ministry of Health Malaysia, Pharmaceutical Services Division


Acknowledgement

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

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


Thank you

CPA-MPS CONFERENCE 2007

MEDICATION REVIEW SYMPOSIUM4th August 2007

Thank You

Prepared by:

Mohd Dziehan Mustapa

Pharmacist U41

Pharmaceutical Services Division

Health Department Of Selangor

(PKD Kuala Langat)


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