Impact of a comprehensive medication management program on ambulatory care patients with noncommunicable diseases in a Latin American hospital: A retrospective study

Abstract

Background: Noncommunicable diseases are the leading causes of death and disability in the world, harming life conditions and increasing expenditures within the health care system. Comprehensive Medication Management (CMM) may improve patient safety, adherence, and clinical outcomes by preventing or intervening in drug-related problems (DRPs). Methods: Retrospective, cross-sectional study conducted between October 2017 and July 2022 in a CMM of a hospital in Costa Rica. Patients 3-106 years old diagnosed with at least one chronic disease and had risk factors for DRP were included. A clinical pharmacist (CP) identified DRPs and proposed interventions to resolve them. DRPs were classified into four categories: indication, effectiveness, safety, and adherence. Additionally, the severity of the problem was determined by using a scale of potential clinical consequences avoided related to DRPs and medication errors (MEs). The adherence rate was determined by applying validated questionnaires and traceability control of dispensing medication dates. Clinical outcomes were classified as resolved, improved, stable, worsened, and therapeutic failure according to the condition of the DRP until the last appointment by the patient. Results: Pharmacotherapy interventions had an overall acceptance rate of 98.3%. Interventions made by the CP were related to effectiveness (38.9%, n = 253), safety (29.6%, n = 193), adherence (20.90%, n = 136), and therapy indications (10.60%, n = 69). The patient adherence rate improved, with a mean value of 74% on the first appointment compared with 88% as the last value calculated after the pharmacist's interventions. Predominant determinants of medication nonadherence were therapyrelated factors (30.88%) and patient-related factors (30.15%). In the clinical status assessment of 651 DRPs, 490 (75.3%) resolved, 105 (16.1%) improved, 43 (6.6%) remained stable, 5 (0.8%) worsened, and 8 (1.2%) patients presented with therapeutic failure. Conclusions: CPs can help resolve DRPs/MEs which enable patients to achieve medication-related therapeutic goals. The clinical interventions made were