Pharmacy Practice: Monitoring, Adherence & Follow-Up

Drug Monitoring

• Primary Goal: Optimize drug therapy to achieve desired therapeutic outcomes while minimizing adverse effects.
• Therapeutic drug monitoring: Ensures medications are at the optimal level in the body.
• Laboratory tests:
  • Ramipril: Monitor the patient's response to Ramipril by checking blood pressure and serum potassium levels.
• Purpose of conducting laboratory tests:
  • Determine the efficacy and safety of drugs
  • Identify potential drug interactions
  • Monitor drug levels in the body
• Digoxin:
  • Volume of distribution: Approx. 7 L
  • Half-life: 36 hours in patients with normal renal function
  • Therapeutic level: 0.8 to 2.0 ng/mL (Clinical Pharmacy and Therapeutics)

Adherence, Compliance, and Concordance

• Adherence: The extent to which the patient takes their medicines as prescribed.
• Compliance: The extent to which the patient’s behaviour matches the prescriber’s recommendations.
• Concordance: Collaboration between the clinician and patient in designing a treatment regime.
• Identify non-adherence:
  • Observe directly or through medication refill records.
  • Ask the patient about their medication use.

Medication Management

• Transfer of Care Around Medicines (TCAM): Aims to improve the safety and effectiveness of medication use at transitions of care.
• Discharge Medication Service (DMS): Assists patients in transitioning to home care.
• Platform for achieving TCAM: Digital platforms like Medication Management system.
• Specialist Pharmacy Service (SPS): Focuses on supporting patients with complex medication needs.
• Medication review: A comprehensive assessment of a patient's medications.
• Types of medication reviews:
  • Holistic medication review: Considers all aspects of a patient's medicine use.
• Purpose of medication review:
  • Identify and address potential medication-related problems
• Medication review in secondary care:
  • Purpose: Ensure appropriate prescribing and minimize adverse drug reactions.
  • Assessment during review:
    • Current medicines
    • Patient's health
    • Any potential problems
• Medication reconciliation during admission: Ensure continuity of care by reviewing the patient's medications and making necessary adjustments.
• Common problem in clinical medication reviews: Incomplete medication history.
• Medication review in primary care: To identify and address potential medication-related problems in the community.
• Role of healthcare professionals in medication review:
  • GP/Pharmacist/Advanced nurse practitioner: Lead medication reviews, provide advice and support to patients.
• Definition of medication review according to NICE: A structured process of considering a patient's medication needs where the patient's medication use is reviewed and adjustments are made based on a consideration of their individual needs.
• Purpose of medication review tools: To guide healthcare professionals in performing comprehensive reviews.
• Percentage of patients who take their medicines as prescribed, experience no problems, and receive as much information as they need: 50%.
• Intentional non-adherence: The patient chooses to take their medications differently than prescribed (e.g., due to cost, side effects, or disbelief in its effectiveness).
• Unintentional non-adherence: The patient forgets to take their medication or has difficulty understanding and following their medical instructions.
• Recording patient discussions and advice: Use clear and concise language that captures key details about medications, including any changes, concerns, and advice provided.
• Defining new medication: Include the name, dosage, frequency, and any special instructions for administration.

Test your knowledge of drug monitoring, adherence, and follow-up methods in primary and secondary care, including the role of pharmacists in identifying and supporting non-adherence. Explore different transfer of care methods and understand the importance of structured medication reviews.