Medication therapy management services in emergency and ambulatory care of Gondar University Hospital, northwest Ethiopia

Abstract

Background: Clinical pharmacists (CP) providing medication therapy management (MTM) services have shown significant positive therapeutic outcomes by identifying and resolving patients' drug therapy problems (DTPs). Objective: Thus, the aim of the study is to evaluate and characterise the type of interventions provided by CPs through MTM services in emergency and ambulatory settings in Gondar University Hospital (GUH), northwest Ethiopia. Methods: This is a prospective cross-sectional study carried out in emergency and ambulatory settings during February-July 2015 at GUH, Ethiopia. The CP interventions documented through MTM services were collected and analysed using SPSS version 22. A p-value ≤0.05 was considered to be statistically significant.Results: A total of 182 patients with 335 interventions were recorded, of which the majority were from the ambulatory ward (63.1%) particularly, cardiovascular patients (25.8%). CPs identified at least one DTP per patient, such as 'need for additional drug therapy' (30.5%) and 'unnecessary drug therapy' (29.5%). The interventions provided by CPs were providing information (32.5%), start/stop medications (25.7%), alteration of duration, frequency and dosage (11.6%). Of 335 interventions, 257 (76.7%) were accepted by physicians. CP interventions were about four times more likely to be accepted by physicians in patients with comorbidities (adjusted odds ratio = 3.70, 95% CI = 1.959-6.99) than those with no comorbidity. Conclusion: CP interventions through MTM documentations revealed identification of patient drug-related problems and have shown acceptance by the majority of physicians. We recommend the use of MTM services in other wards of the GUH.

Impact of medication therapy management service on selected clinical and humanistic outcomes in the ambulatory diabetes patients of Tikur Anbessa Specialist Hospital, Addis Ababa, Ethiopia

“…Those carried out in Asia and Africa reported an average of 1–3 DTPs per patient [ 10 – 13 ]. A similar rate of DTPs has been reported by various studies conducted in Ethiopia [ 14 – 16 ]. Drug-related hospital admissions are also significantly increasing overtime.…”

“…The increased proportion of elderly population as well as disease duration would also likely increase the risk of ADRs. By contrast, other studies conducted in Gondar [ 14 ] and Jimma [ 15 ] (Ethiopia), India [ 10 ], and USA [ 18 ] reported needing additional therapy and taking unnecessary drug therapy were the most prevalent DTPs. Difference in study settings, socio-demographic characteristics, recruitment criteria, pharmacist clinical skills and tools used for DTP assessment might explain the discrepancy.…”

Facilitating respectful interprofessional communication: how do we get there?

“…The success of these services relies on successful interprofessional communication and practice. For example, the authors of the study from Ethiopia highlight that: ‘In this study, it was observed that 32.5% of the interventions were to provide drug information for the patients in collaboration with physicians’ (emphasis added). The four papers described above specifically involve research about practice with doctors, yet, interestingly, none of the papers included interprofessional authorship.…”

“…Articles in this issue of the Journal of Pharmacy Practice and Research describe research related to the implementation of a range of new services, including the benefits and acceptability of medicines reviews being undertaken by pharmacists in a hospital in Ethiopia and the acceptability to physicians in Bangladesh of pharmacists increasing their roles in consulting with them and advising them about patients’ medicines . In Australia, formal communication under a government‐subsidised medicines review program between patients’ general medical practitioners (GPs) and a consultant pharmacist revealed deficiencies in the GPs’ knowledge of their patients’ current medicines, which the pharmacist discussed with the GP .…”

“…The language used in articles throughout this issue includes words such as ‘interventions’, ‘discrepancies’ and similar expressions, and, in the UK paper, medical practitioners are described as ‘medics’ . The Ethiopian paper similarly highlights the heterogeneity of terms for clinical pharmacy and a reminder that we have different language both intra‐ and interprofessionally . Language is a conduit to cooperation and sharing ideas, but differences in language use can impose barriers.…”