Abstract

Diabetes was increased in Thailand with increasing burden of morbidity and mortality. There were 42.8% of diabetes patients in Bangkok who had been treated, but the disease conditions were uncontrolled. Diabetes with drug related problems (DRPs) frequently occurred, leading to problems of uncontrolled disease conditions. The objective of this study was to apply chronic care model (CCM) which has been introduced using medication therapy management (MTM) services by community pharmacist home health care and monitor patients’ drug utilization in diabetic patients at home. An action research was conducted in the community in Bangkok Metropolitan. The uncontrolled diabetes conditions were purposively selected and identified by nurse home care team. The community pharmacists provided the MTM service 3 times as the delivery service design template that was planned over the 6‑month period. The study implemented on CCM with MTM services as the main delivery system. The outcomes were evaluated on three aspect of ECHO model. Data were gathered for 288 uncontrolled diabetic patients with high prevalence of drug related problems. The number of drug were taking mean standard deviation (SD) 7.1 (3.1) per patient at enrollment. The 2.98 number problems per patient and 95.8% non-adherence were identified by community pharmacist. After 3 interventions, non-adherent patients’ state was changed to adherent medication level and partially medication adherent level by 18.2 and 26.0%, respectively. The pharmacists identified problems and improved in safety issues (adverse drug reactions, drug interactions), adherence issue and effectiveness issue (sub-therapeutic dosage). The clinical outcome found the average systolic and diastolic blood pressures to improve significantly in 48.6% patients with hypertension including those in pre-hypertension, stage I and stage II. The data was limited and results showed that the fasting plasma glucose (FPG) was not significantly reduced from baseline due to lack of linkage among hospital and community settings. The non-compliance issue had an effect on excessive medications per patient on the average of $543.24 per year. This study concluded that implementation MTM service through CCM by community pharmacist home health care could alleviate patients’ medication utilization problems and would thus improve overall quality of patient care.

Key words: Chronic care model (CCM), drug related problems (DRPs), medication adherence, home health care, medication therapy management (MTM)