Home medication management review in outpatients with chronic diseases in Jordan: a randomized control trial

摘要

Background Medication Management Review (MMR) is a patient-focused, structured and collaborative health care service provided in the community setting to optimize patient understanding and quality use of medicines. Objective To conduct a randomized control trial of the MMR program in Jordan, by a pharmacist identifying treatment related problems (TRPs) through home visits, assessing type and frequency of TRPs, and eventual effect of resolving TRPs identified by the pharmacist and accepted by the physician on the health status of participating patients. Setting Outpatient clinic at the Jordan University Hospital, Amman, Jordan. Method Consecutive patients from outpatient clinics who were eligible for the study were recruited and randomly distributed into two groups (control and intervention). All patients were visited at home by the pharmacist who delivered only for intervention group counseling regarding self-reported adherence, frequency of monitoring and education regarding pharmacological and non-pharmacological therapy. After identifying TRPs, the pharmacist sent a letter to the physician with certain recommendations for patients in the intervention group only. Physician ticked the approved recommendations and returned the report to the pharmacist, allowing the pharmacist to convey the approved changes to the patients. Patients were referred back to their physicians for confirmation of any changes in treatment. Both groups were reassessed after 2-3 months during their regular follow-up visits to their physicians. Main outcome measure To assess the impact of home medication review on the number of TRPs and self-reported adherence in outpatients with chronic diseases via hospital-based clinics in Jordan. Results A total of 158 TRPs were identified in 112 patients; mean TRP number was 1.63 per patient. As a result of the pharmacist intervention, there was a significant decrease in number of TRPs in the intervention group, the change in the mean was (1.23 (+/- 1.19), P < 0.001) versus the control group (0.29 (+/- 1.24), P = 0.114). After 3 months, a reduction in non-adherence was observed in the intervention (-0.81 (+/- 1.48), P < 0.001) in contrast to no change in self-reported adherence in the control (0.22 (+/- A 1.12), P = 0.168) group. Conclusion Overall, home-based medication review for patients with chronic conditions decreased the total number of TRPs and improved patient self-reported adherence.