Adaku Efuribe
Healthcare delivery is evolving and multidisciplinary team approach has become an indispensable tool for universal healthcare delivery.
According to the Royal Pharmaceutical Society “medicines optimisation represents that step change. It is a patient-focused approach to getting the best from investment in and use of medicines that requires a holistic approach, an enhanced level of patient centered professionalism, and partnership between clinical professionals and a patient.â€
I believe medicines optimisation is about ensuring that patients receive the right kind of medication at the right time and medicines use review is a step in the right direction towards achieving this.
Evidence has shown that a good number of medicines prescribed end up not being taken due to lack of concordance and compliance.
My experience in community pharmacy with patient returned medication has shown that patients who do not understand the rationale for prescribed medication are more likely not to use the medication.
Also medicines which are prescribed for preventative measures tend not to be taken as patients do not see the immediate benefits most times. A lot of work needs to be done in the area of patient education and information provided through medicines use reviews.
The gains of patient entered care cannot be overemphasised, all medical needs have to be tailored to the individual patient, considering their personal circumstances, other co-morbidities, and sometimes frailty comes into play for elderly patients as well.
There has been a drive for more social prescribing, motivational counseling and interventions for patients who have suffered medical emergencies or patients with long term conditions as these has shown to be beneficial in improving the well-being of patients.
Loneliness especially in the elderly contributes to depression and could make dementia related symptoms worse. As medicines optimisation put patients in the centre of care, clinicians need to work together to ensure adequate measures are put in place and everyone contributes their own quota.
Multidisciplinary team approach is needed where every member of the healthcare team contributes their expertise to patient centred care.
The role of the pharmacist towards patient centred care cannot be overemphasised and integrated healthcare approach enhances delivery of outcomes.
For instance, a patient with swallowing difficulties would benefit from having solid medication forms converted to liquid preparations or orodispersible forms. Another good example is topical medication used for treating eczema, patients with arthritis may not be able to bend over or apply medication on some areas of the skin that is not easily reachable.
It is during the medication review process that such issues are discussed and problems of non-compliance solved.
In the cause of completing a medication review with one of my patients, it came to light why the patient’s COPD (Chronic obstructive pulmonary disease) was not well managed as the patient thought tiotropium capsules that were dispensed was meant to be swallowed whole with a glass of water.
This patient happened to be visually impaired and was unable to read the small printed instructions on the dispensing packaging and thus just believed tiotropium capsules needed to be swallowed and not used with the inhalation device.
After I offered education, guidance and support to this patient, the patient was able to use the capsules with her inhaler device properly and her COPD symptoms were well controlled eventually thus a possible COPD exacerbation or even hospital admission was avoided.
Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring like methotrexate,NOAC’s, digoxin and diuretics to mention but a few.
As part of the medication review process, blood tests are routinely checked, because if dosage regimens are not adjusted or vital blood checks are not made, this may lead to increased harm to the patient or even death.
I’m calling on all healthcare professionals to embrace patient centred care and also provide the enabling environment for multidisciplinary team approach in the management of diseases. Pharmacists have a major role to play towards achieving this by providing efficient medicines optimisation services.
Efuribe is Medicines Management consultant and United Nations SDG Advocate
