TITLE:
Impact of Pharmaceutical Care on Self-Administration of Outpatient Low-Molecular-Weight Heparin Therapy
AUTHORS:
Seraina Mengiardi, Dimitrios A. Tsakiris, Viviane Molnar, Urs Kohlhaas-Styk, Michael Mittag, Stephan Kraehenbuehl, Kurt E. Hersberger
KEYWORDS:
Low-Molecular-Weight Heparin; Outpatients; Subcutaneous Injections; Self Administration; Pharmaceutical Care; Community Pharmacy; Switzerland
JOURNAL NAME:
Pharmacology & Pharmacy,
Vol.5 No.4,
April
10,
2014
ABSTRACT: Outpatient
subcutaneous (s.c.) therapies are becoming more and more common in the
treatment of different diseases. The effectiveness of community-pharmacy-based
interventions in preventing problems that arise during s.c. self-injections of
low-molecular-weight heparins (LMWH) is unknown. Our objective was to provide a
standard operating procedure (SOP) for community pharmacists and to compare
pharmaceutical vs. standard care in both clinical and daily life settings. We
hypothesized that: pharmaceutical care results in improved adherence, safety,
and satisfaction, and in fewer complications; the interventions used are
feasible in daily life; and the results achieved in clinical and daily life
settings are comparable. In the clinical setting (randomized controlled trial),
patients were recruited sequentially in hospital wards; in the daily life
setting (quasi-experimental design with a comparison group), recruitment took
place in community pharmacies by pharmacists and trained master students during
their internship. Interventions were offered according to patient needs. Data
were collected by means of a monitored self-injection at home and structured
questionnaire-based telephone interviews at the beginning and the end of the
LMWH treatment. The main outcome measures were: scores to assess patient’s
skills; syringe count to assess adherence; and frequency, effectiveness, and
patient’s assessment of received interventions. The results show a median age
of the 139 patients of 54 years. Interventions resulted in improved application
quality (p p = 0.03). Oral instructions were
pivotal for improving patients’ application quality. We found no significant
score differences between the intervention groups in the clinical and daily life
settings. Patients’ baseline skills were high, with the lowest score being 0.86
(score range ?2.00 to +2.00). Adherence rate was high (95.8%). In conclusion,
our SOP for pharmacist interventions was of good quality, adequate, appreciated,
and feasible in daily life. Patients are capable of managing s.c. injection
therapies if adequate assistance is provided.