Background and importance This project focused on direct interaction between hospital pharmacists and patients, through clinical pharmaceutical counselling. Drug safety and patient well-being are promoted and possible user errors and uncertainties concerning the medication and interactions are communicated directly. During the consultation patients were given the opportunity to ask questions, express uncertainties and receive information regarding their medication. Two different settings for the project (outpatient and inpatient) allowed investigation of which questions were of primary concern in these different situations.
Aim and objectives Most chronic obstructive pulmonary disease (COPD) patients have up to at least three comorbidities in addition to their primary pneumological disease. These can affect the heart, bones, metabolism and/or psyche, among others. Therefore polymedication is almost inevitable. Clinical-pharmaceutical counselling of patients is intended to promote adherence and medication safety. Especially for these patients, adherence to therapy is crucial and close monitoring of the medication is essential. This patient-oriented service is intended to be a tool for optimal drug therapy, since it has already been shown that clinical-pharmaceutical interventions, such as the targeted education of patients, can reduce adverse drug events and readmissions.
Material and methods A guideline with predefined questions about health status, medication scheduling, intake modalities, uncertainties, and a final satisfaction survey was created in order to be able to offer a comparable consultation to all patients. Prior to the consultation, patient records were reviewed and the medication was checked for possible interactions using drug interaction software programs.
Results It could be shown that the consultation for the inpatient area was related to medication changes during the stay and the expected benefits from those changes, thus promoting the patients’ medication knowledge for the time after hospital discharge, whereas most outpatients’ questions were about self-medication and over the counter (OTC) drugs. In this cohort some examples of severe drug interactions could be found.
Conclusion and relevance In summary, this medication consultation benefits the patients by increasing their knowledge regarding their medicine which leads to better adherence and therefore less rehospitalisation, therefore showing a high impact for the work of clinical pharmacists.
Conflict of interest No conflict of interest
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