Wong, ICK; (2017) Improving Medication Safety and Diabetes Management in Hong Kong – A Multi-disciplinary Approach. Hong Kong Medical Journal , 23 (2) pp. 158-167. 10.12809/hkmj165014.

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Abstract

AIM: To characterise drug-related problems (DRPs) among patients with diabetes in Hong Kong and their clinical significance and to explore pharmacists’ role in the multi-disciplinary diabetes management team by evaluating the outcome of their clinical interventions. METHODS: An observational study was conducted at the Diabetes Clinic of a local public hospital from October 2012 to March 2014. Following weekly screening, selected high-risk patients were interviewed by a pharmacist prior to doctors’ consultations for medication reconciliation and review. DRPs were identified and documented by the pharmacists, who presented clinical recommendations to doctors to optimise patients’ drug regimens and resolve or prevent potential DRPs. RESULTS: A total of 522 patients were analysed and 417 DRPs were identified. The incidence of patients with DRPs was 62.8% with the mean number of DRPs per patient being 0.9±0.6. The most common DRP categories were related to dosing (43.9%), drug choice (17.3%) and non-allergic adverse reactions (15.6%). Drugs most frequently involved targeted the endocrine and cardiovascular system (CVS). The majority (71.9%) of DRPs were of moderate clinical significance and 28.1% were considered minor problems. DRPs were totally solved by doctors’ acceptance of pharmacists’ recommendations (50.1%), partially solved (11.0%) or received acknowledgement from doctors (5.5%). CONCLUSIONS: Pharmacists, in collaboration with the multi-disciplinary team, demonstrated positive impact by identifying, resolving and preventing DRPs in patients with diabetes. Further plans for sustaining a pharmacy service in the Diabetes Clinic would enable further studies to explore pharmacists’ long-term impact on improving patients’ clinical outcomes in diabetes management. New knowledge added by this study: Studies have demonstrated pharmacists’ important contribution to the identification, resolution and prevention of drug-related problems through medication reconciliation and review. Most of the identified problems were related to dosing with moderate clinical significance according to Dean and Barber’s validated scale for scoring medication errors. Over half of pharmacists’ clinical interventions were accepted or acknowledged by doctors to improve medication management. IMPLICATIONS FOR CLINICAL PRACTICE OR POLICY: Collaboration between pharmacists and other healthcare professionals is valuable for the improvement of medication safety in the management of diabetes.

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