Informing policy makers in developing countries: Practices and limitations of geriatric home medication review in Malaysia-A qualitative inquiry

Abstract

Objective: To explore existing practices and challenges in the delivery of geriatric home medication review (HMR). The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR.

Methods: This study employed qualitative exploratory design through semi-structured individual in-depth interviews with the public pharmacists involved in the delivery of geriatric HMR at public hospitals. The purpose of the interviews was to explore challenges faced by them in the delivery of geriatric HMR.

Results: Based on the emerging themes from the qualitative data, the study reveals that geriatric HMR in Malaysia is integrated as part of multidisciplinary home care visits, encompassing a diverse patient population with various healthcare needs. However, it faces challenges such as the lack of outcome monitoring, formal training, and workforce constraints. Despite these hurdles, there is a pressing need for the expansion of this service to better serve the community, and collaboration with community pharmacists holds potential to broaden its scope. Ultimately, the findings suggest that pharmacist- led HMR is both warranted and feasible within the Malaysian healthcare context. In order to optimize medicine-use among older people living in the community, approaches for expanding geriatric HMR services in Malaysia must be developed.

Conclusions: This study holds profound implications as it attempts to illuminate policy makers in developing countries, enabling them to formulate effective HMR plans. By considering the challenges highlighted within this research, policy makers can design a comprehensive HMR service that caters adeptly to the healthcare needs of the mass population.

Keywords

Home medication review / Older adults / Malaysia / Pharmacists / Low-to-middle-income countries

References

[1] Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, et al. Adverse drug events in ambulatory care. N Engl J Med 2003; 348(16): 1556-1564.

[2] Lavan AH, Gallagher P. Predicting risk of adverse drug reactions in older adults. Ther Adv Drug Saf 2016; 7(1): 11-22.

[3] Hatah E, Tordoff J, Duffull SB, Braund R. Pharmacists' performance of clinical interventions during adherence support medication reviews. Res Social Adm Pharm 2014; 10(1): 185-194.

[4] Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol 2012; 74(4): 573-580.

[5] Papastergiou J, Zervas J, Li W, Rajan A. Home medication reviews by community pharmacists: Reaching out to homebound patients. Can Pharm J 2013; 146(3): 139-142.

[6] Kwint H, Faber A, Gussekloo J, Bouvy M. The contribution of patient interviews to the identification of drug-related problems in home medication review. J Clin Pharm Ther 2012; 37(6): 674-680.

[7] Pechlivanoglou P, Abrahamyan L, MacKeigan L, Consiglio GP, Dolovich L, Li P, et al. Factors affecting the delivery of community pharmacist-led medication reviews: Evidence from the MedsCheck annual service in Ontario. BMC Health Serv Res 2016; 16(1): 1-12.

[8] MOH HMR Protocol. Home medication review protocol. 2011. [Online]. Available from: https://www.pharmacy.gov.my/v2/en/documents/home-medication-review-protocol.html. [Accessed on 28 July 2022].

[9] MOH . Home care pharmacy services protocol. 2nd 2019. [Online]. Available from: https://www.pharmacy.gov.my/v2/sites/default/files/document-upload/home-care-pharmacy-services-protocol-2nd-edition-2019.pdf. [Accessed on 28 July 2022].

[10] Lenaghan E, Holland R, Brooks A. Home-based medication review in a high-risk elderly population in primary care-the POLYMED randomized controlled trial. Age Ageing 2007; 36(3): 292-297.

[11] Sorensen L, Stokes JA, Purdie DM, Woodward M, Elliott R, Roberts MS. Medication reviews in the community: Results of a randomized, controlled effectiveness trial. Br J Clin Pharmacol 2004; 58(6): 648-664.

[12] Medicare Benefit Schedule. The Australian Government Department of Health and Ageing. 2012. [Online]. Available from: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/276B8A3E93673BECCA257CCF00051C25/$File/201212-Allied.pdf. [Accessed on 28 July 2022].

[13] Flanagan PS, Barns A. Current perspectives on pharmacist home visits: Do we keep reinventing the wheel? Integr Pharm Res Pract 2018; 7: 141-159.

[14] Hassali MAA, Shafie AA, See OG, Wong ZY. Pharmacy practice in Malaysia pharmacy practice in developing countries. US: Academic Press, Elsevier; 2016, p. 23-40.

[15] Mohd-Tahir NA, Paraidathathu T, Li SC. Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system. SAGE Open Med 2015; 3: 2050312115596864. doi: 10.1177/2050312115596864.

[16] Gudi SK, Kashyap A, Chhabra M, Rashid M, Tiwari KK. Impact of pharmacist-led home medicines review services on drug-related problems among the elderly population: A systematic review. Epidemiol Health 2019; 41: e2019020.

[17] Holland R, Lenaghan E, Harvey I, Smith R, Shepstone L, Lipp A, et al. Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. BMJ 2005; 330(7486): 293.

[18] Jatau AI, Aung MMT, Kamauzaman THT, Rahman AFA. Prevalence of drug-related emergency department visits at a teaching hospital in Malaysia. Drugs Real World Outcomes 2015; 2: 387-395.

[19] Gershon RR, Pogorzelska M, Qureshi KA, Stone PW, Canton AN, Samar SM, et al. Home health care patients and safety hazards in the home: Preliminary findings. In: Kerm H, James BB, Margaret AK, Mary LG. (eds.) Advances in patient safety: New directions and alternative approaches. Rockville, MD: Agency for Healthcare Research and Quality; 2008.

[20] Kendra MA, Weiker A, Simon S, Grant A, Shullick D. Safety concerns affecting delivery of home health care. Public Health Nurs 1996; 13(2): 83-89.

[21] IMU News. Pharmacist shares her experience on home medication review. 2015. [Online]. Available from: http://imunews.imu.edu.my/people/alumni/pharmacist-shares-experience-home-medication-review/. [Accessed on 28 July 2022].