Effectiveness of a Pharmaceutical Care-based Program to Improve Medication Adherence in Elderly Patients Receiving Polypharmacy in a Community Hospital in Kanchanaburi
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Abstract
Objective: To evaluate the effectiveness of a pharmaceutical care-based program (PCP) to improve medication adherence (MA) in elderly patients receiving polypharmacy in a community hospital. Method: The research was a study with one group with the measurement of MA before and after the provision of PCP in elderly patients taking at least 4 chronic medications with low MA i.e., less than 80% or more than 120% of MA as measured by pill count and getting the score less than 22 as measured by the Medication Taking Behavior in Thai (MTB-Thai). The provision of PCP followed the PCP guidelines developed in the study to promote MA including patient education, aids for drug taking behaviors such as drug preparation in a ready-to-take form and review of drug use. The PCP was provided for 2 times i.e., at the chronic disease clinic at the beginning of the study, and at the 4th week. The study measured MA in the 4th and 8th week. The patient was considered as having good MA if pill count showed 80-120 percent of drug taking and having the score on MTB-Thai at least 22. Results: There were 30 elderly patients in the study, 26 females, with an average age of 70.4 ± 9.0 years. All patients had 2 or more chronic diseases with either diabetes, high blood pressure, dyslipidemia as comorbidity. The average of medications taken per day was 7.0 ± 1.8 items. Common problems of MA were skipping medications in some certain times (n=24) and not taking medications (n=15). Most commonly used MA promotion activities were provision of knowledge and advice and review of drug use. The average MA levels for chronic medications at the beginning and at the end of the study was 70.47% and 96.61%, respectively, as measured by pill count, while medians of MTB-Thai score method were 19 and 23 points, respectively. The level of MA increased significantly (p <0.001). The number of patients with adequate MA increased significantly to 21 subjects in the 4th week and further increased to 27 subjects in week 8. Conclusion: The PCP developed in the study has the clear guidance for selecting tools or activities promoting medication adherence for the individuals more appropriately. Therefore, it can improve the adherence in the elderly receiving polypharmacy
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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