Effects of the Provision of Pharmaceutical Care at Home to Patients on Management of Drug-related Problems in Diabetic Patients Using Pen-filled Insulin Injections in Khao Chakan District, Sa Kaeo Province

Abstract

Objective: To assess the effect of providing pharmaceutical care to patients at home on the management of drug-related problems, knowledge and skill of patients or caregivers on the use of pen-filled insulin injections, and clinical outcomes. Methods: This study was a one group with pretest and posttest after provision of pharmaceutical care at home for at least 3 months in all patients using pen-filled insulin injections with HbA1c> 7 mg% or visiting emergency department at Khao Chakan Hospital for hyperglycemia or hypoglycemia. The study gathered data from the INHOMESSS assessment and management of drug related problems according to the guidelines of the National Institutes of Health. Pharmaceutical Care Network Europe (PCNE). Results: There were 31 participants in the study with mean age of 62.65±12.22 years. The INHOMESSS assessment revealed drug related problems in all patients, followed by nutrition problem (80.65% of patients). Based on the PCNE assessment, there were 99 drug related problems. Most of them were the problem on efficacy (82.82%). The assessment identified 190 causes of problems. The most common causes were related to patients (52.11%). Of the 246 resolution of problems used, most were targeted at the patients or caregiver (63.82%). After provision of pharmaceutical care at home, 58.59% of the problems were completely resolved, the other 35.35% were partially resolved. Knowledge on insulin injection increased from 4.81±2.07 to 7.77±2.17 out of the full score of 10 (P<0.001). Skill on injection of insulin increased from 14.42±3.16 to 16.77±2.32 from a full score of 20 (P<0.001). Fasting blood glucose decreased from 207.16±66.62 mg/dl to 162.19±39.27 mg/dl (P=0.001), and HbA1c decreased from 9.29±1.91 mg% to 7.82±1.96 mg% (P<0.001). Conclusion: Provision of pharmaceutical care at home in patients using pen-filled insulin injection was able to resolve drug related problems. Patient's knowledge and skills of using pen-filled insulin injection increased, consistent with clinical outcomes on lower fasting blood glucose and HbA1c.