Development of Refill Clinic for Non-Communicable Diseases in Ranong Hospital

Abstract

Objective: To develop refill clinic in patients with non-communicable diseases in Ranong Hospital. Methods: This action research was conducted in 39 patients with hypertension and/or diabetes who could control their blood pressure and/or sugar levels and having no serious complications. Patients refilled their medication and received pharmaceutical care from the pharmacist in refill clinic for 2 times 3 months apart (month 0 and 3). Studied clinical outcomes included blood pressure, fasting blood sugar (FBS) and medication adherences assessed 3 times by pill counting and the Medication Taking Behavior measure for Thai patients at month 0, 3 and 6 after participating in the research. In addition, HbA1c was measured twice at month 0 and 6. Patient satisfaction with services from the refill clinic and internal medicine clinic was evaluated at month 3 and 6. Satisfaction among staff on the refill clinic was assessed one week after the start of the clinic.  Results: Three assessments of clinical outcomes showed that average systolic/diastolic blood pressures were 136.41 ± 12.11 / 78.87 ± 9.39, 135.56 ± 13.50 / 79.18 ± 10.48 and 134.38 ± 14.18 / 76.21 ± 8.14 mmHg, respectively (P=0.60 and 0.11 for systolic/diastolic blood pressures, respectively).  Average FBSs were 130.50 ± 13.81, 132.69 ± 12.34 and 132.25 ± 13.10 mg/dl, respectively (P=0.74). HbA1c levels measured at month 0 and 6 were 7.16 ± 0.62 and 6.98 ± 0.50%, respectively (P=0.17). All differences in clinical outcomes did not reach statistically significant levels. Three assessments by pill count showed the levels of medication adherence at 84.29 ± 6.00, 89.55 ± 3.09 and 91.35 ± 3.08%, respectively (P<0.001), while those assessed by the MTB-Thai showed the mean scores of 23.35 ± 0.90, 23.79 ± 0.52 and  23.97 ± 0.16 (out of the full score of 24), respectively (P<0.001). Overall medication adherence scores significantly increased. Waiting times in the refill clinic were less than that in internal medicine clinic (43.84 ± 1.59 and 107.59 ± 6.48 minutes, respectively; P<0.001) Patients’ satisfaction scores on the refill service were higher than those of the internal medicine clinic but did not reach statistically significant levels (4.00 ± 0.65 and 4.69 ± 0.52, respectively, from the full score of 5; P=0.64). Health professionals were satisfied with the service of the refill clinic and wanted its services to be provided together with internal medicine clinic on a regular basis. Conclusions: The services from the refill clinic provided by pharmacists for patients with non-communicable diseases with well controlled blood pressure and sugar levels achieved clinical outcomes comparable to those in internal medicine clinic. However, medication adherence in those in refill clinic was higher.