Effects of home drug delivery on drug-related problems: preliminary evidence for improved patient outcomes during the COVID-19 pandemic in Thailand

Abstract

Background Drug-related problems cause severe disabilities, premature deaths, and unnecessary costs. Telepharmacy offer easier access to needed medications, preventing DRPs. Adoption has been slow, and it is unclear what aspects of telepharmacy are most important. The COVID-19 pandemic disrupted health services, forcing the rapid adoption of telepharmacy. In Phayao, Thailand, a program was implemented for home delivery of drugs for chronic disease patients. Objectives This study aimed to explore the prevalence and factors associated with DRPs of chronic disease patients who received home drug delivery services. Methods A cross-sectional study was undertaken in Phayao Province located in North Thailand. Simple random sampling was used to select patients from six public hospitals between July and August 2020. Logistic regression was used to analyze multivariate factors that might be related to DRPs. Results 246 participants reported at least one DRP (49.30%). Most participants were female (58.32%) with elementary education (60.72%). Their mean age was 63.69 (SD=12.97) years. The five most common DRPs were changes of drug packaging or drug brands (18.84%), leftover medications of more than two weeks (18.44%), non-adherence (17.43%), having conditions or diseases requiring additional medications (6.81%), and adverse drug reactions (5.21%). Univariate analysis identified number of chronic conditions, diabetes mellitus, dyslipidemia, chronic kidney disease, education level and drug delivery channel as predictors of DRPs. In multivariate analysis, predictors of DRPs were the number of drugs used per day (adjusted odds ratio [aOR] 1.11 [95%CI 1.03-1.19], p=0.004) and dyslipidemia (aOR 1.83 [95%CI 1.18-2.84], p=0.007. Non-adherence was associated with leftover medicines (aOR 4.22 [95%CI 2.44-7.28], p<0.001) Conclusion The present results indicate that home delivery caused no increase and may have caused a decrease in DRPs and patients were highly satisfied. These promising results suggest that home delivery should be continued and further investigated even as the COVID-19 induced emergency subsides.

Home delivery of medications: Community pharmacists' perspectives on the pros and cons of the service

“…Therefore, there is a need for studies with a stronger methodological rigor to thoroughly address this regard. Despite the fact that the implementation of home delivery of medications is associated with several pros, such as treatment continuity, economic savings, decongestion of the healthcare centers, avoiding traveling expenses, saving patients' time, and enhancing the quality of life (10,17), there are potential drawbacks that should be highlighted. First, implementing a home drug delivery service without integrating it with the telepharmacy system, compromises the optimal provision of the pharmaceutical care (2).…”

“…However, an important fact that this study revealed is that a high proportion of these experienced pharmacists believe that much important information may be skipped if medications are not dispensed face to face at the pharmacy site. This could be particularly true in patients on complex regimens, such as anticoagulants, insulin therapy, and antiepileptic drugs ( 10 ). In light of these findings, integration of telehealth services among home delivery services would be extremely important in covering this missing aspect.…”

“…A recent study found that patients on maintenance medications through home delivery are more likely to take them as prescribed for conditions like diabetes, hypertension, and dyslipidemia ( 13 ). However, previous studies that investigated the benefits of home delivery services were self-administered questionnaires susceptible to social desirability bias ( 10 , 12 , 14 – 17 ). Therefore, there is a need for studies with a stronger methodological rigor to thoroughly address this regard.…”

Public Perceptions About Home Delivery of Medication Service and Factors Associated with the Utilization of This Service

“…Surprisingly, a recent study conducted in Thailand reported that the prevalence of drug-related problem from home drug delivery was as high as 49% and the most common type of errors was associated with change in drug packaging and drug brand. The latter may lead to confusion and precipitate other types of drug-related problems, such as patient's lack of compliance and adverse events in case the drug-related problem was not detected 26 .…”

“…The most common types of these errors include for instance, medicines delivered to wrong patients, wrong labelling in the delivered package, inappropriate patient counseling, and suboptimal medication therapy management. 25,26 As such, more research is needed to explore this service, and maximize the benefit from it by understanding the public perspective 8 . Thus, the aims of this study are to investigate the public's perception of the home delivery of medication service that was offered by some community pharmacies in Jordan and to evaluate factors affecting the use of this service.…”