1 Introduction
A drug-related problem (DRP) is defined as “an event or circumstance
involving drug therapy that actually or potentially interferes with
desired health outcomes” [1]. Strong evidence had shown that the
negative outcomes associated with DRPs are a major health issue [2].
The majority of hospitalizations and emergency department visits caused
by DRPs were preventable, and an effective drug review for the
successful detection of DRPs remains an unmet clinical need.
Population aging is a global phenomenon [3]. Aging is accompanied
with decline of functional reserves and adaptability. Elderly patients
also often have concomitant medical conditions that require multiple
drugs. It is well known that polypharmacy is very common in elderly
patients and increases the risk of adverse drug events (ADEs), potential
drug–drug interactions and drug errors [4], in addition it has
considerable impact on morbidity and mortality [5].
Health care providers must carefully investigate the use of drugs to
identify the DRPs, and try to solve these DRPs, especially the elderly
[6, 7]. Pharmacists are ideal medical team member to optimize drug
therapy, adjust drug doses, conduct medication reconciliation, improve
drug compliance, monitor laboratory
indicators,
conduct patient education where appropriate [8]. By performing
medication review or medication therapy management (MTM), the pharmacist
can identify and resolve the DRPs [9]. MTM services has been
demonstrated positive effects on drug compliance, clinical effectiveness
and safety [10-12]. The core elements of MTM services include
medication therapy review (MTR), a personal medication record (PMR), a
medication-related action plan (MAP), intervention and referral, and
documentation and follow-up [13].
In order to determine
the
effectiveness of MTM services to identify DRPs in elderly patients (age
≥ 65) in outpatients, we evaluated the incidence and characteristics of
DRPs in outpatient patients conducted by a group of pharmacists. This
study also examined clinical outcomes (blood pressure (BP), and
lipids) pre- and post-intervention
by pharmacist. Thus, the purpose of this manuscript is to assess the
impact of pharmacist-led MTM for ambulatory patients.