Profiling Outpatient Medication Therapy Problems in a Tertiary Government Hospital: A Framework-based Analysis of a Patient Medication Counseling Program

Background. Patient medication counseling (PMC) is an essential service across the healthcare system to deliver comprehensive medication management, which includes patient medication profiling as an attempt to identify potential medication therapy problems in patients. Implementation of the PMC program in a clinical setting was executed to promote optimal medication management.

Objective. The objective of this study is to describe the medication therapy problems (MTPs) of patients referred to a pharmacist-initiated patient medication counseling service in a tertiary government hospital.

Methods. The study implemented a retrospective cross-sectional records review of PMC sessions conducted by student and faculty-preceptor pharmacists in the General Medicine service of the Internal Medicine Outpatient Department of a tertiary government hospital. The PMC service and data collection were conducted between April 12 and May 31, 2023. MTPs identified during the counseling session were categorized using the Pharmacy Quality Assurance MTP Categories Framework. The study utilized frequency statistics and logistic regression to analyze the collected data.

Results. There were 121 counseled patients included in the study. Most are practicing polypharmacy (76.03%), and less than half (41.31%) are using pharmaceutical devices. Patients with an increasing number of medications have 1.18 odds (95%CI [1.0256-1.3576]; p = 0.021) of experiencing MTPs in their drug regimen. Out of all included patients, 86 (71.07%) were identified to have at least one MTP, with adherence-related MTPs being the most common (39.31%). Among these, directions not understood by the patients (47.22%) were the most frequently encountered problem.

Conclusion. This study shows that a pharmacist-led medication counseling program is a useful intervention to identify MTPs, especially for polypharmacy. Continuity of the program is important to observe whether pharmacologic and clinical outcomes of pharmacist recommendations are met by patients receiving medication counseling.