Authors (including presenting author) :
Lee TPH (1), Li CHY (1), Chan TCC (1), Leung SYP (1), Loong CHN (2), Wong VKC (1), Lee ACH (2), Wong HSY (1), Woo YC (2)
Affiliation :
(1) Department of Pharmacy, Queen Mary Hospital
(2) Division of Endocrinology & Metabolism, Department of Medicine, The University of Hong Kong, Queen Mary Hospital
Introduction :
With an aging population and the increasing prevalence of chronic diseases, coupled with a shortage of healthcare manpower, Specialist Out-patient Clinics (SOPCs) are under immense pressure - patients may have to wait for over a year for a doctor's consultation, and doctors have tightly constrained time to thoroughly assess conditions and identify drug-related problems.
Prescribing a long duration of medications to patients without interim review may pose risk to patients' safety. In April 2024, the Pharmacy department in Queen Mary Hospital (QMH) collaborated with the division of Endocrinology, Diabetes & Metabolism under Department of Medicine to establish a Clinical Pharmacist-led clinic for managing patients with primary hypothyroidism, diabetes and osteoporosis. This clinic will provide interim pharmacist consultations for these patients.
Objectives :
To evaluate the safety and effectiveness of a Clinical Pharmacist-led, protocol-driven clinic for primary hypothyroidism, diabetes and osteoporosis.
Methodology :
From April to June 2024 (2Q 2024), patients from the thyroid clinic, diabetes clinic, and osteoporosis clinic of QMH were referred to Clinical Pharmacists for interim consultations according to predefined criteria. Physicians may extend their follow-up interval for these patients upon referral to Clinical Pharmacist. During pharmacist consultations, treatment response was assessed by monitoring patients’ vital signs, clinical signs and symptoms, relevant investigation reports and laboratory results. Clinical Pharmacists also reviewed patients' latest medication profiles to identify potential drug-related problems, such as adverse effects, and medication adherence. In addition to monitoring of drug therapy, Clinical Pharmacists would conduct dose titrations according to predefined protocol, which includes Levothyroxine for patients with hypothyroidism and antihypertensive medications for diabetic patients, when appropriate. Physicians would be contacted for early follow-up if any concerning conditions requiring early medical attention were identified.
Result & Outcome :
During the study period, a total of 237 pharmacist consultations were conducted. Clinical Pharmacists performed 43 medication titrations, which included Levothyroxine, antihypertensive medications, and other drugs upon discussion with physicians. 101 drug-related problems were identified. These issues included incorrect administration methods, intentional or unintentional non-adherence, and potential drug interactions with other chronic medications, over-the-counter drugs, or supplements. Drug counselling, pharmaceutical advice and interventions were provided to address these drug-related problems to ensure optimal treatment outcomes.
