Patient-centred monitoring in chronic disease management in the community pharmacy

Abstract

Chronic diseases present a number of challenges for healthcare systems worldwide. Community pharmacists are in a unique position to participate in the chronic care of their patients through patient monitoring and medication management. The aim of this research was to evaluate the impact of a pharmacist-led chronic disease management service by identifying drug-related problems (DRPs) and assessing the pharmacist intervention on patient health outcomes. A chronic disease management service was implemented in a community pharmacy. Fifty patients taking at least one chronic medication were recruited. Two medication review sessions were held; an initial session and a follow-up session after 4 months. During the sessions, point-of-care testing for blood pressure, blood glucose and HbA1c monitoring as well as lifestyle advice were provided. A pharmaceutical care plan with recommendations to solve DRPs was developed for each patient. Forty-eight patients completed the study, with a mean age of 69 years and taking an average of 5 medications daily. A total of 207 DRPs were identified with a mean of 4.25 DRPs per patient, which mainly involved undertreatment (18.8%), monitoring (18.4%) and compliance (17.9%) issues. Most DRPs were solved (78.6%) or partially solved (16.5%). Following the pharmacist intervention, there was a decrease in systolic blood pressure by 10mmHg (p<0.001), diastolic blood pressure by 4mmHg (p=0.001), fasting blood glucose by 1.7mmol/L (p<0.001) and HbA1c level by 0.5% (p<0.001). Medication compliance improved from a mean score of 17.7 to 21.7 out of a total score of 25 (p<0.001) and patient satisfaction increased from a mean score of 2.61 to 4.11 after intervention out of a total score of 5 (p<0.001). The patient-centred monitoring service had a significant positive impact, suggesting that expanding the role of community pharmacists in chronic disease management can improve patient health outcomes.