Outcomes of Service Provision Based on Multidisciplinary Pharmaceutical Care Model in Thai Traditional Medical Cannabis Clinics at Huaikoeng Hospital in Udonthani

Abstract

Objective: To measure the outcomes of providing services according to the multidisciplinary pharmaceutical care model (MPCM) at Thai Traditional Medical Cannabis Clinic Huaikoeng Hospital in Udonthani (Cannabis Clinic). Method: This study was a part of action research following the planning phase. The study consisted of 3 phases: 1) action phase involved the collection of data on drug related problems (DRPs) among 120 outpatients regularly receiving services at the Cannabis Clinic. The patients with chronic musculoskeletal pain, migraine, insomnia, and cancer accounted for 30.8%, 26.6%, 17.5%, and 7.5% of the total subjects, respectively. Later, the service based on the MPCM designed in the planning phase was provided to the patients for 3 months; 2) observation phase was to evaluate the outcomes after implementing the MPCM by observing the change in the average number of DRPs; and 3) The reflection phase was to conduct focus group discussion in multidisciplinary teams to collect their opinions on the MPCM. Results: The total number of DRPs before the implementation of the MPCM was 81 with an average of 0.68 DRP per patient. After the implementation of the MPCM, DRPs significantly decreased to 10 times, or an average of 0.08 DRP per patient (P = 0.045). During the periods before and after the introduction of the MPCM, DRPs affecting patient safety were more prevalent than those affecting treatment. The most common cause of DRPs was inappropriate behaviors on drug use among patients. It was found that the number of inappropriate behaviors decreased from 44 times to 4 times (reduced by 90.9 percent) after the MPCM was introduced. In the period before the MPCM was introduced, pharmacists resolved DRPs with 81 attempts by coordinating with physicians, nurses, other pharmacists within and outside the hospital, patients and their caregivers. A total of 77 recommendations by pharmacists for DRPs (95.0%) were accepted. 105 patients (87.5%) had improved treatment outcomes after the implementation of the MPCM. In the reflection phase, multidisciplinary team agreed that the participatory designed MPCM was beneficial to patient, improved the quality of work system and should be implemented in ongoing practice. Conclusion: Service provision based on the MPCM in the Cannabis Clinics reduces DRPs at both the patient and prescriber levels. Pharmacists play an important role in identifying, preventing, and resolving DRPs together with the multidisciplinary team and patients. As a result, treatment outcomes and patient safety are improved. Therefore, the MPCM should be implemented in ongoing practice within the Cannabis Clinics.