Medication counseling beyond instituitional: impact of pharmacist-led home medication review in type 2 diabetes patients [Abstract]

Objectives
To evaluate the impact of home medication review programme (HMR) towards Type 2 Diabetes patients from public primary centre in Penang, Malaysia.

Methods
A prospective randomised control study was conducted at Primary Clinic in Bukit Minyak, Penang. Eligible Type 2 diabetes patients with HbA1c > 6.5% and taking ≥ 3 medications who stayed at their own house were recruited and randomly allocated into control and intervention group by coin tossing. Control group patients received usual care from the clinic whereas intervention group patients received additional 2 visits at their home by pharmacist. During both visits, education on quality use of medications and life-style modifications were performed.Blood pressure monitoring, point of care for sugar and total cholesterol levels were conducted in each visit. Patients adherence and knowledge were assessed using validated questionnaire. Pill count was conducted and excessive medications were collected to calculate the costing component. Primary outcomes were medication adherence and level of knowledge. Secondary outcomes included HbA1c, FBS and total cholesterol changes as well as patients’ satisfactions towards HMR and direct cost saving from the programme.

Results
A total of 150 patients were recruited and randomly assigned in two groups (n=75 each group). Fifty patients in the intervention group completed the study. After 2 home visits there were significant improvements in the adherence score for the intervention group (mean score=6.90,SD=0.94) compared to the control group (mean score=4.05, SD=1.51). There was a significant improvement in knowledge score after HMR programme, intervention group (mean score=10.04, SD=1.75) and the control group (mean score=5.45, SD=1.89). A direct cost analysis of the medication wasted reveals that HMR can help to save RM 2805.50 (USD 855.34) throughout the eight months period.

Conclusions
Pharmacist-led HMR have improved patients’ adherence and knowledge as well as helping the policy makers to save money on excessive medication wastage.