Effect of educational intervention on medication reconciliation practice of hospital pharmacists in a developing country - A non-randomised controlled trial

Abstract

Background: Medication reconciliation is an evidence-based practice that reduces medication-related harm to patients. This study evaluated the effect of educational intervention on medication reconciliation practice of pharmacists among ambulatory diabetes and hypertensive patients.

Methods: A non-randomized clinical trial on medication reconciliation practice was carried out among 85 and 61 pharmacists at the intervention site and control site, respectively. Medication reconciliation was carried out among 334 (intervention-183; control-151) diabetes and/or hypertensive patients by the principal investigator to indirectly evaluate pharmacists' baseline medication reconciliation practice at both sites. A general educational intervention was carried out among intervention pharmacists. Medication reconciliation was carried out by the principal investigator among another cohort of 96 (intervention-46; control-50) and 90 (intervention-44; control-46) patients at three and six months postintervention, respectively, to indirectly assess pharmacists' postintervention medication reconciliation practice. Thereafter, a focused educational intervention was carried out among 15 of the intervention pharmacists. Three experts in clinical pharmacy analysed the medication reconciliation form filled by the 15 pharmacists after carrying out medication reconciliation on another cohort of 140 patients, after the focused intervention. Data was summarized with descriptive (frequency, percentage, mean ± standard deviation) and inferential (Pearson product-moment correlations analysis, independent-samples t-test and one-way ANOVA) statistics with level of significance set at p<0.05.

Key findings: Baseline medication reconciliation practice was poor at both sites. Post-general educational intervention, medication discrepancy was significantly reduced by 42.8% at the intervention site (p<0.001). At the intervention site, a significant increase of 54.3% was observed in patients bringing their medication packs for clinic appointments making medication reconciliation easier (p=0.003), at 6-months postintervention. Thirty-five, 66 and 48 drug therapy problems were detected by 31 (43.1%), 33 (66.0%) and 32 (71.1%) intervention pharmacists at 1-, 3- and 6-month post-general educational intervention, respectively. Post-focused educational intervention, out of a total of 695 medications prescribed, 75 (10.8%) medication discrepancies were detected and resolved among 42 (30%) patients by the 15 pharmacists.

Conclusions: The educational interventions improved pharmacists' medication reconciliation practice at the intervention site. It is expected that this research would help create awareness on medication reconciliation among pharmacists in developing countries, with a view to reducing medication-related patient harm.

Keywords: Diabetes; Drug therapy problems; Educational intervention; Hospital pharmacist; Hypertension; Medication discrepancy; Medication reconciliation.

Fig. 1

CONSORT for study pharmacist-participants. Interv. = Intervention PI = Postintervention CTAGC = Chief Toni Anenih Geriatric Center. GEI = General educational intervention FEI = Focused educational intervention

Fig. 2

CONSORT for study patient-participants. CTAGC = Chief Toni Anenih Geriatric Center Both = Diabetes and Hypertension. CONSORT = Consolidated Standards of Reporting Trial PI = Postintervention. GEI = General educational intervention FEI = Focused educational intervention. NB: Patients selected for each phase of the study were cohorts and not the same sets. Total patient population = 660