Opportunities for pharmacists to optimise quality use of medicines in a Sri Lankan hospital: an observational, prospective, cohort study

Perera, D.M.P., Coombes, J.A., Shanika, L.G.T., Dawson, A., Lynch, C., Mohamed, F., De Silva, H.A., Jayamanne, S.F., Peters, N.B., Myers, B. and Coombes, I.D., 2017. Opportunities for pharmacists to optimise quality use of medicines in a Sri Lankan hospital: an observational, prospective, cohort study. Journal of Pharmacy Practice and Research.

Abstract

Background

Quality use of medicines (QUM) has been identified as a priority in Sri Lanka.

Aim

To identify opportunities to optimise QUM, and evaluate medication appropriateness and medication information exchanged with patients and carers on discharge in a Sri Lankan tertiary care hospital.

Methods

An observational, prospective, cohort study of patients systematically sampled from two medical wards. A research pharmacist determined their pre-admission medication regimen via interview at time of discharge. Issues of poor adherence and discrepancies between the pre- and post-admission medication regimens were recorded. Drug-related problems were categorised into opportunities to optimise drug therapy. The appropriateness of discharge medications was evaluated using a validated tool. The patient or carer was interviewed after discharge regarding the quality of medicine information exchanged in hospital.

Results

The 578 recruited patients were taking 1756 medications prior to admission, and 657 (37.4%) of these medications were not continued during admission. Opportunities to optimise drug therapy were identified on 1496 occasions during admission (median, 2.0 opportunities/patient), 215 opportunities, (14.4%) were resolved spontaneously by the medical team prior to discharge. The median score for appropriateness of medications on discharge was 1.5 per patient (interquartile range, 0.0–3.5). Of 427 patients surveyed after discharge, 52% recalled being asked about their medications on admission to hospital, 75% about previous adverse medication reactions and 39% recalled being informed about changes to their medications on discharge.

Conclusion

Significant opportunities exist for pharmacists to enhance quality use of medicines for patients in the current hospital-based healthcare system in Sri Lanka.

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