Browsing by Author "Coombes, J."

Now showing 1 - 18 of 18

Acceptance and attitudes of healthcare staff towards the introduction of clinical pharmacy service: a descriptive cross-sectional study from a tertiary care hospital in Sri Lanka
(Biomed Central, 2017) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; Mamunuwa, N.; Dawson, A.H.; de Silva, H.A.
BACKGROUND: Multidisciplinary patient management including a clinical pharmacist shows an improvement in patient quality use of medicine. Implementation of a clinical pharmacy service represents a significant novel change in practice in Sri Lanka. Although attitudes of doctors and nurses are an important determinant of successful implementation, there is no Sri Lankan data about staff attitudes to such changes in clinical practice. This study determines the level of acceptance and attitudes of doctors and nurses towards the introduction of a ward-based clinical pharmacy service in Sri Lanka. METHODS: This is a descriptive cross-sectional sub-study which determines the acceptance and attitudes of healthcare staff about the introduction of a clinical pharmacy service to a tertiary care hospital in Sri Lanka. The level of acceptance of pharmacist's recommendations regarding drug-related problems (DRPs) was measured. Data regarding attitudes were collected through a pre-tested self-administered questionnaires distributed to doctors (baseline, N =13, post-intervention period, N = 12) and nurses (12) worked in professorial medical unit at baseline and post-intervention period. RESULTS: A total of 274 (272 to doctors and 2 to nurses) recommendations regarding DRPs were made. Eighty three percent (225/272) and 100% (2/2) of the recommendations were accepted by doctors and nurses, respectively. The rate of implementation of pharmacist's recommendations by doctors was 73.5% (200/272) (95% CI 67.9 - 78.7%; P < 0.001). The response rate of doctors was higher at the post-intervention period (92.3%; 12/13) compared to the baseline (66.7%; 8/12). At the post-intervention survey 91.6% of doctors were happy to work with competent clinical pharmacists and accepted the necessity of this service to improve standards of care. The nurses' rate of response at baseline and post-intervention surveys were 80.0 and 0.0% respectively. Their perceptions on the role of clinical pharmacist were negative at baseline survey. CONCLUSIONS: There was high acceptance and implementation of clinical pharmacist's recommendations regarding DRPs by the healthcare team. The doctors' views and attitudes were positive regarding the inclusion of a ward-based pharmacist to the healthcare team. However there is a need to improve liaison between clinical pharmacist and nursing staff.
Adverse Drug reactions and associated factors in a cohort of Sri Lankan patients with non-communicable chronic diseases
(Pharmaceutical Society of Sri Lanka, 2016) Shanika, L.G.T.; Jayamanne, S.; Coombes, J.; Coombes, I.; Wijekoon, C.N.
Adverse drug reactions in a cohort of Sri Lankan patients with non-communicable chronic diseases
(Elsevier, 2017) Wijekoon, C.N.; Shanika, L.G.T.; Jayamanne, S.; Coombes, J.; Dawson, A.
BACKGROUND: Adverse drug reactions (ADRs) pose a major problem in medication use. This study was done to describe incidence, nature and associated factors of ADRs in a cohort of Sri Lankan patients with non-communicable chronic diseases (NCCDs). METHODS: The prospective observational data presented here are obtained as a part of a large study conducted in a tertiary-care hospital in Sri Lanka. In-ward patients with NCCDs were recruited systematically using the admission register in the ward as the sampling frame. All ADRs occurred during the index hospital admission and 6-month post-discharge period were detected by active surveillance. RESULTS: 715 patients were studied (females – 50.3%; mean age – 58.3±15.4years). 35.4% were aged ≥65years. Mean number of drugs prescribed per patient was 6.11±2.97. Most prevalent NCCDs were hypertension (48.4%), diabetes (45.3%) and ischemic heart disease (29.4%). 154 ADRs [33 (21.4%) during index hospital admission; 121 (78.6%) during 6-month post-discharge period) were detected involving 112 (15.7%) patients. 51.9%(80/154) of them were potentially avoidable. 47% (73/154) of ADRs were serious adverse events (SAEs); 13 were life threatening, 46 caused hospitalization and 14 caused disability. The most common causes for re-hospitalization due to ADRs were hypoglycemia due to anti-diabetic drugs (17/46), bleeding due to warfarin (6/46) and hypotension due to anti-hypertensives (6/46). ADRs were more common in elderly (34% vs 14.7%, p<0.001), in those who were on ≥5 drugs (25.9% vs 12.7%, p<0.001) and among those with diabetes (28.5% vs 15.6%, p<0.001). CONCLUSIONS : Incidence of ADRs was high in the study population. A large proportion of them were SAEs. The majority of ADRs that required re-hospitalization were caused by widely used drugs and were potentially avoidable. Factors associated with a higher incidence of ADRs were age ≥65years, ≥5drugs in the prescription and presence of diabetes. The healthcare system in the study setting needs improvement in order to minimize ADRs.
Adverse drug reactions in a cohort of Sri Lankan patients with non-communicable chronic diseases
(Sri Lanka Medical Association, 2016) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; de Silva, H.A.; Dawson, A.
INTRODUCTION AND OBJECTIVES: Adverse drug reactions (ADRs) are a major problem in drug utilization. The study aimed to describe the incidence and nature of ADRs in a cohort of Sri Lankan patients with non-communicable chronic diseases (NCCDs). METHOD: This prospective observational study conducted in a tertiary-care hospital recruited in-ward patients with NCCDs. All ADRs that occurred during the index hospital admission and in the 6-month period following discharge were detected by active surveillance. Details were recorded using the ADR reporting form, developed based on the publication of the Clinical Center, Pharmacy Department, National Institutes of Health. RESULTS: 715 patients were studied (females-50.3%, mean age–57.6 years). The mean number of medicines given per patient was 6.11±2.97. The most prevalent NCCDs were hypertension (48.4%; 346/715), diabetes (45.3%; 324/715) and ischemic heart disease (29.4%; 210/715). 112 patients (15.7%) experienced at least one ADR. In the 112 patients, 154 ADRs (33 during index hospital admission; 121 during 6-month period following discharge) were detected. 51.9% (80/154) of them were potentially avoidable. 47% (73/154) of ADR swere Serious Adverse Events (SAEs); 13 were life threatening, 46 caused hospitalization and 14 caused disability. The most common causes for re-hospitalization due to ADRs were hypoglycemia due to anti-diabetic drugs (17/46), bleeding due to warfarin (14/46) and hypotension due to anti-hypertensives (6/46). CONCLUSIONS: Incidence of ADRs was high in the study population. A large proportion of them were SAEs. The majority of ADRs that required re-hospitalization were caused by widely used medicines and were potentially avoidable.
Case report: Opportunities for Medication Review and Reconciliation by a Clinical Pharmacist to Prevent Drug-Related Hospital Re-Admissions: Evidence from a Case Series in Sri Lanka
(Pharmaceutical Journal of Sri Lanka, 2018) Shanika, L.G.T.; Wijekoon, C.N.; Jayamanne, S.; Coombes, J.; Perera, D.; Pathiraja, V.M.; Mamunuwa, N.; Mohamed, F.; Coombes, I.; Lynch, C.; de Silva, H.A.; Dawson, A.H.
ABSTRACT: Medication review by a clinical pharmacist improves quality use of medicines in patients by identifying, reducing and preventing drug related problems and hospital re-admissions. This service is new to Sri Lanka. We present two cases from a non-randomized controlled trial conducted in a tertiary care hospital in Sri Lanka. The first case is from the control group where no clinical pharmacist was engaged and the next case is from the intervention group. The first case was a drug related hospital re-admission because of missing medicines in the discharge prescription and the second case was a re-admission which was prevented by the intervention of a ward pharmacist by performing a clinical medication review of the prescription.
A case series of duplication errors due to brand name confusion - experience from a Sri Lankan teaching hospital
(Sri lanka Medical Association, 2015) Mamunuwa, A.M.V.G.N.; Jayamanne, S.F.; Coombes, J.; Lynch, C.B.; Perera, D.M.P.; Pathiraja, V.M.; Shanika, L.G.T.; Mohamed, F.; Dawson, A.H.
INTRODUCTION AND OBJECTIVES: Confusion with drug names has been identified as a leading cause of medication errors. The majority of these errors result from look-alike or sound-alike drugs. This case series aims to provide examples of duplication errors due to brand confusion where there are no similarities in the names. METHOD: Information for this case series was extracted from a database prospectively collected from Colombo North Teaching Hospital as part of a study conducted to evaluate the impact of the addition of a clinical pharmacist to the standard inpatient care. RESULTS: Of 800 patients reviewed during the study period of 7 months, clinical pharmacist identified 8 cases of duplication errors due to prescribing both generic and brand names of the same drug, but with no similarities in names. Cases identified include a duplication of frusemide caused by the lack of awareness that 'Amifru' {a combination of frusemide and amiloride) contains frusemide. Similarly, a patient was prescribed 'H. Pylori Kit' plus the three individual drugs included in the 'Kif prescribed using their generic names. A patient was found to be taking two different brands of carbidopa plus levodopa not knowing the two contained the same drugs. CONCLUSION: Brand confusion does not necessarily arise from look-alike or sound-alike drug names. It can be due to numerous brands of generic ingredients and lack of awareness of drug names among the patients. Employing trained clinical pharmacists in the wards, educating patients on discharge drugs and appropriate labeling of medicines may prevent these errors.
A clinic-based pharmacy counselling service to improve medication adherence among diabetes out-patients
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Mamunuwa, N.; Jayamanne, S.; Coombes, J.; de Silva, A.; Lynch, C.; Wickramasinghe, D.
The burden of diabetes is increasing with the rising prevalence of the disease and its complications. Medication adherence is a significant factor in the management of diabetes. Pharmacists’ role in the improvement of medication adherence is well-studied in the world. Despite the high and rising prevalence of diabetes in Sri Lanka, this is the first study to evaluate a pharmacy counselling service in a Sri Lankan diabetes population. To assess how a clinic-based pharmacy counselling service may affect patient medication adherence. 400 consecutive patients with diabetes mellitus attending outpatient medical clinics at Colombo North Teaching Hospital were randomized into either intervention group (IG) or control group (CG). Patients in the IG received pharmacist counselling (verbal and written) for four consecutive monthly visits in addition to standard care at the clinic, while patients in the CG received standard care only. Adherence for both groups was measured at baseline and post intervention using ©Morisky Medication Adherence Scale (8-Items). Mean age of the participants was 61.79 ± 9.06 and 67% were female. The IG had a median score of 4 out of 8 (IQR 5-3) at baseline which increased to 7 (IQR 8-6) after intervention. The median score of the CG was not significantly changed; 5 (IQR 7-4) at baseline and 5 (IQR 7- 6.5) after intervention period. Patients in the IG had a statistically significant improvement in adherence compared to the CG, using the Mann-Whitney U test (P<0.005). The IG had a 74.15% improvement in adherence whereas the CG had an improvement of 1.78%. Pharmacist counselling in outpatient clinics can improve medication adherence of the patients with diabetes.
Clinical Pharmacists‟ Interventions to Improve Inhaler Use among Chronic Kidney Disease (CKD) Patients.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Wickramasinghe, N.D.D.; Lynch, C.B.; Coombes, J.; Jayamanne, S.F.; De Silva, S.T.
Inappropriate use of asthma inhalers can lead to increased hospitalizations, reduced quality of life (QOL), loss of productivity and increased health related costs. Pharmacist-led interventions have shown an improvement of inhaler technique and use. The following cases describe opportunities for clinical pharmacist-led interventions to resolve problems associated with inhaler use identified from an ongoing study in renal clinic, Teaching Hospital, Anuradhapura.
Drug related problems among patients with diabetes; a descriptive analysis of data from an urban hospital in Sri Lanka
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Mamunuwa, N.; Jayamanne, S.; Coombes, J.; de Silva, A.; Lynch, C.; Wickramasinghe, D.
Drug related problems (DRPs) result in reduced quality of care and even morbidity and mortality. The aim of this study is to assess the frequency and nature of DRPs and their causes among patients with diabetes attending an outpatient clinic. The prospective study was conducted in medical clinics of Colombo North teaching hospital and included 400 outpatients with diabetes. The identified DRPs were classified according to Pharmaceutical Care Network Europe tool (PCNE V6.2). A total of 151 DRPs were detected. The highest number of DRPs (61.58%) related to treatment effectiveness while 21.19% related to treatment costs, 9.93% related to adverse effects and 7.28% related to other non-classified problems. The most common DRP identified was ‘effect of drug treatment not optimal’ (39.73%) followed by ‘unnecessary drug treatment’ (16.55%) and ‘untreated indication’ (12.58%). Half (50.33%) of the DRPs detected were caused by the way patients use the medicines, in spite of proper prescribing and instructions. This included ‘deliberate under-use of the drug’ (61.84%), ‘drug not taken at all’ (15.78%), ‘inability to use the drug as directed’ (9.21%) and ‘drug overuse’ (6.57%). 31.12% of the DRPs were related to selection of drugs including ‘inappropriate drug’ (40.42%), ‘drug required not given’ (23.4%) and ‘duplications’ (21.27%). DRPs are frequent among diabetes outpatients. Early detection and addressing the causes of the actual and potential DRPs may improve the quality use of medicines and ensure safe, appropriate and cost-effective out-patient care.
Duplication errors due to brand name confusion; It is not always the name-Short case series
(John Wiley & Sons, 2023) Mamunuwa, N.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Perera, D.; Shanika, T.; Mohamed, F.; Lynch, C.; de Silva, A.; Dawson, A.
Confusion of drug names has been identified as a leading cause of medication errors and potential iatrogenic harm. Most of these errors occur because of look-alike or sound-alike drugs. This case series gives examples of duplication errors due to brand confusion, where there are no similarities in the names.
Impact of a ward based clinical pharmacist intervention on improving the quality use of medicines in patients with chronic non communicable diseases in a tertiary hospital
(Sri Lanka Medical Association, 2014) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Coombes, I.; Perera, D.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: To investigate the impact of a ward based clinical pharmacy service (CPS) on appropriate prescribing of discharge medications. METHODS: This is a non-randomised controlled trial conducted to assess CPS in a medical unit. Eligible patients admitted with non-communicable chronic diseases were considered. The female and the maie wards were the control and intervention during initial phase. Groups were swapped between two wards during next phase. The control patients received usual management. Intervention received CPS in addition to the existing management. Both clinical and demographic data were collected until discharge. Appropriateness of prescribing was assessed at discharge with the Medication Appropriateness Index (MAI). RESULTS: 354 (2140 medications) and 359 (2232 medications) patients' data were evaluated respectively in, control and intervention. Medications received per patient in both groups were similar. Appropriateness of discharged medications in intervention' group was significantly higher compared to control, 66% (235/359) and 34% (120/354) respectively (p< 0.0001). Furthermore, the mean MAI score per patient was significantly lower in intervention compared to th.e control (0.99 vs. 4.1, p< 0.001). Proportion of appropriate prescriptions in relation to all MAI criteria was significantly lower in intervention group compared to the control, all (p< 0.01). Among the drugs prescribed in the intervention [5% (112/2232)] and control groups, [20% (420/2140)] respectively had at least one inappropriate MAI criterion (p< 0.0001). CONCLUSIONS: This study demonstrates that a ward based CPS can reduce inappropriate prescribing of medications at discharge providing an opportunity to improve quality use of medicine.
Impact of a ward-based clinical pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases
(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Coombes, I.; Perera, D.; Pathiraja, V.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: This is the first study done in Sri Lanka to evaluate the benefit of a ward-based pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases. METHOD: This is a part of a controlled trial conducted in a tertiary care hospital to evaluate ward-based clinical pharmacy service. Intervention group (IG) received a ward-based pharmacist's service during hospitalization to optimize the patients' drug therapy. At discharge the pharmacist counseled patients regarding all aspects (name, indication, dose, frequency, side effects, and actions for side effects, timing, monitoring and storage) of long term medications and written instructions were also provided. Control group (CG) received usual care without a ward-based pharmacist. The knowledge and adherence were assessed over the phone on the 6th day after discharge by a different pharmacist. Previously validated knowledge and adherence questionnaires were used. RESULTS: There were 334 and 311 patients in the IG and CG, respectively, The IG had a significantly higher average medication knowledge compared to the CG {IG-75.81+19.14 vs. CG-40.84+19.20; P < 0.001). Proportion of drugs with correct answers, to all 9 dimensions tested, was greater in the IG compared to the CG (P < 0.001). IG had a significantly higher medication adherence score compared to the CG (IG-92.97±15.04 vs. CG-80.42±28,29; P <0.001). A significantly large number of individuals in the IG had high adherence score on Morisky adherence scale compared to the CG (P < 0.001). CONCLUSION: Discharge counseling by a ward-based pharmacist improves medication knowledge and adherence of patients on long term medications.
Impact of a ward-based clinical pharmacy service in reducing drug-related hospital re-admissions in patients with chronic non-communicable diseases; evidence from a controlled trial in Sri Lanka
(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Mamunuwa, N.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: Literature showed that pharmacists' interventions helped to reduce drug related hospital re-admissions. The objective of this study was to determine the impact of a ward-based clinical pharmacy service on drug related hospital re-admissions in Sri Lanka. METHOD: This was a part of a controlled trial conducted in a tertiary care hospital in Sri Lanka to evaluate the clinical pharmacy service. The intervention group (IG) received a clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases. clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases.
Importance of communicating medication changes to patients at discharge -a prospective case study
(Sri lanka Medical Association, 2015) Pathiraja, V.M.; Jayamanne, S.F.; Lynch, C.B.; Coombes, J.; Perera, D.M.P.; Mamunuwa, A.M.V.G.N.; Shanika, L.G.T.; Mohamed, F.; Dawson, A.H.
INTRODUCTION AND OBJECTIVES: Patients may inadvertently continue their previous medication regimen without understanding changes made by prescribers as part of in-patient care. Inadequate patient education at discharge can lead in some instances to readmission and increased morbidity. The objective of this study is to identify the importance of patient education with regard to changes to their medications. METHOD: This study was part of a prospective study carried out in two medical wards of Ragama teaching hospital to evaluate the effect of a clinical pharmacist's interventions on quality use of medicines. We identified cases from the control group of this study to illustrate the importance of patient education at discharge. RESULTS: From telephone follow-up (six days post discharge), only 89 of 337 patients in the control group reported being informed of changes to their pre-admission medications by a doctor or nurse. There were!24 cases where we have identified patients continuing at least one pre-admission medication which was stopped or changed while they were in hospital. A particular instance is a patient who continued to take sodium valproate post-discharge as per previous drug regimen after being diagnosed with valproate induced hepatitis. He was discharged on phenytoin. CONCLUSION: This study highlights the importance of ensuring patient education about changes made to existing medications whilst in hospital to ensure improved outcomes and reduce the risk of adverse events. The clinical pharmacist is well placed to assist medical teams by providing patients with appropriate education about medication changes and to provide appropriate educational material.
Pharmacist counselling: A new practice for improving out-patient management of diabetes in Sri Lanka
(Sri Lanka Medical Association, 2018) Mamunuwa, A.M.G.N.; Coombes, J.; Lynch, C. B.; de Silva, A.; Wickramasinghe, N.D.D.; Jayamanne, S.F.
INTRODUCTION AND OBJECTIVES: Our study assessed the effectiveness of pharmacist counselling on outpatient management of diabetes. Though this is new to Sri Lanka, many countries include this practice to achieve target treatment outcomes of patients with diabetes.METHODS: 800 participants with diabetes attending outpatient clinics of two Sri Lankan hospitals were assigned either intervention group (IG) or control group (CG). IG received pharmacist counseling for four consecutive monthly visits in addition to standard care. CG received standard care only Glycaemic control was assessed using Glycosylated haemoglobin (HbAlc) post-intervention Adherence and patient-knowledge were assessed using questionnaires at baseline and post-intervention. RESULTS: A Wilcoxon signed-rank test showed that the 4-month intervention made a statistically significant improvement in adherence in the IG. The IG had median adherence score of 5 out of 8 (IQR 6-3 3) at baseline which increased to 7 (IQR 8-6) post-intervention There was no significant change in adherence in the CG.The IG had median HbAlc of7.2% (IQR 1.5%) post-intervention whereas CG had median of7.7% (IQR 1.95%). This difference was statistically significant.The IG had a median score of 36. l 5% (IQR 48% - 24.07%) for the medication related knowledge domain which increased to 65% (IQR 76.4% - 50.4%) post-intervention (P value< 0 001). The CG did not have a significant change in the same at baseline and post-intervention (P = 0 15). CONCLUSION: Pharmacist counselling improved medication adherence, glycaemic control and patients' knowledge. Thus, it can effectively be used for improving the outpatient management of diabetes in Sri Lanka.
The role of pharmacist counselling in the control of diabetes
(Sri Lanka Medical Association, 2017) Mamunuwa, A.M.V.G.N.; Jayamanne, S.F.; Coombes, J.; de Silva, A.; Lynch, C.B.; Wickramasinghe, N.D.D.
INTRODUCTION & OBJECTIVES: Diabetes is a global health burden. Data in international literature prove the success of involving pharmacists to achieve glycaemic control. This is the first study in Sri Lanka on the impact of pharmacist counselling among outpatients with diabetes. The objective was to assess the impact of pharmacist counselling on glycaemic control of outpatients with diabetes. METHODS: A total of 400 consecutive patients with diabetes mellitus attending the outpatient diabetes clinics at Base Hospital, Dambadeniya, were randomized into either the intervention group (IG) or the control group (CG). IG received pharmacist counselling (verbal and written) for four consecutive monthly visits in addition to the standard care at the clinic, while the CG received standard care only. Glycaemic control was assessed for both groups with HbA1c measured at the end of the four monthly visits.RESULTS: Mean age of participants was 57.14±10.15 years and 67.5% were females. Non parametric tests were performed as data did not follow the normal distribution. On analysis of HbA1c data, the IG had a median of 7.2% (IQR: 8.2%-6.5%) whereas the CG had a median of 7.7% (IQR: 8.8%-6.9%). The IG patients had statistically lower HbA1c levels compared to the CG patients, according to the Mann-Whitney U test (p<0.05). HbA1c levels <8.00% indicate good/fair glycaemic control. 73.9% of the IG, but only 58% of the CG subjects had levels <8.00%. However, 9.1% of the IG and 10% of the CG had very poor glycaemic control (HbA1c level >10.00%). CONCLUSION: Pharmacist counselling in the outpatient clinics can improve the glycaemic control of patients with diabetes.
Should ‘Drug Related Problems’ remain unnoticed among patients with chronic kidney disease of uncertain aetiology?
(Sri Lanka Medical Association, 2023) Wickramasinghe, N.D.D.; Lynch, C.B.; Coombes, J.; Jayamanne, S.F.; de Silva, S.T.
INTRODUCTION: Chronic kidney disease of uncertain aetiology (CKDu) is a major public health concern in Sri Lanka. CKDu patients often consume 10-12 drugs per day, which can result in drug-related problems (DRPs). However, emerging economies such as Sri Lanka have few safeguards in place to detect and report DRPs. OBJECTIVES: The objective of this study was to introduce clinic-based pharmacy services to detect, address and report DRPs that occurred in CKDu out-patients. METHODS: A randomized controlled clinical trial was conducted in pre-dialysis CKDu stages 4 and 5 patients at outpatient renal clinics in Teaching Hospital, Anuradhapura, Sri Lanka. DRPs were identified in both groups at baseline. The control group received usual clinic care while the intervention group received medication counseling by a clinic-based pharmacist. DRPs were identified in both groups after 12 months. RESULTS: At baseline, there were 123 and 126 patients in the control and intervention groups, respectively. 133 and 147 DRPs were identified from 80 and 79 patients in the control and intervention groups, respectively. The median number of DRPs per patient was 1 (1-2) (p=0.458) for both groups. After 12 months, there were 101 and 98 patients in the control and intervention groups, respectively. 137 and 59 DRPs were identified from 57 and 33 patients in the control and intervention groups, respectively. The median number of DRPs per patient was 2 (1-3) and 1 (1-2) (p=0.029) in control and intervention groups, respectively. CONCLUSION: A “clinic-based pharmacist” counselling is a beneficial additional service for identifying and addressing DRPs occurring in patients with CKDu.
Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka
(2018) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, C.N.; Coombes, J.; Perera, D.; Mohamed, F.; Coombes, I.; de Silva, H.A.; Dawson, A.H.
OBJECTIVE: To assess if a ward-based clinical pharmacy service resolving drug-related problems improved medication appropriateness at discharge and prevented drug-related hospital readmissions. METHOD: Between March and September 2013, we recruited patients with noncommunicable diseases in a Sri Lankan tertiary-care hospital, for a non-randomized controlled clinical trial. The intervention group received usual care and clinical pharmacy service. The intervention pharmacist made prospective medication reviews, identified drug-related problems and discussed recommendations with the health-care team and patients. At discharge, the patients received oral and written medication information. The control group received usual care. We used the medication appropriateness index to assess appropriateness of prescribing at discharge. During a six-month follow-up period, a pharmacist interviewed patients to identify drug-related hospital readmissions. RESULTS: Data from 361 patients in the intervention group and 354 patients in the control group were available for analysis. Resolutions of drug-related problems were higher in the intervention group than in the control group (57.6%; 592/1027, versus 13.2%; 161/1217; P < 0.001) and the medication was more appropriate in the intervention group. Mean score of medication appropriateness index per patient was 1.25 versus 4.3 in the control group (P < 0.001). Patients in the intervention group were less likely to be readmitted due to drug-related problems (44 patients of 311 versus 93 of 311 in the control group; P < 0.001). CONCLUSION: A ward-based clinical pharmacy service improved appropriate prescribing, reduced drug-related problems and readmissions for patients with noncommunicable diseases. Implementation of such a service could improve health care in Sri Lanka and similar settings.