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.