Designing the System for Management of Unused Medicine in Patients with Diabetes Mellitus by Using Root Cause Analysis Framework
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Abstract
Objective: The purposes of this study were 1) to investigate number of items, quantity and cost of unused medicines as well as their predictive factors, 2) to analyze root causes of unused medicines, and 3) to design system for management of unused medicine by health care team. Method: The concepts of root cause analysis were used to design three phases of the study including both quantitative and qualitative studies. Phase I was a survey exploring number of items, quantity and cost of unused medicines in 403 diabetic patients. Phase II was a semi-structured interview with 19 patients having the highest number of items of unused medicines and health professionals including one family doctor, one general practitioner, 4 pharmacists and 4 nurses. Finally, phase 3 involved the presentation of the information from phases 1 and 2 to health professional teams, and then applied the concepts of root cause analysis to the problem of unused medicines. Result: The majority of participants being survey on unused medicine was female (73.40 %) with the total cost of unused medicines of 64,119.54 Baht or 159.11 Baht per person on average. Unused medicine with the highest quantity was metformin 500 mg, followed by aspirin 81 mg, glipizide 5 mg, enalapril 5 mg and simvastatin 20 mg, respectively. Metformin 500 mg was unused medicines with the highest cost followed by mixtard 70/30 (vial), hydralazine 25 mg, losartan 50 mg and simvastatin 20 mg, respectively. Predicting factors of having more than 4 items of unused medicines were age 60 years and over (ORadj 0.58, 95%CI 0.36-0.95) and having income of 1,000-5,000 Baht per month (ORadj 0.52, 95%CI 0.32-0.85). Contributing factors for the unused medicines included patient factor (attitude, belief, knowledge of disease and medication, and medication-taking behaviors), system of health care services and other factors (such as a lack of caregivers and community participation). Health team adjusted the roles of doctors, nurses and pharmacists to address the problems of unused medicines and arranged home health care services in diabetic patients. Conclusion: The collaborations within health care team and involvement of patients, family members and community could help develop the system to address the problems of unused medicines effectively and sustainably.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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