Pharmacist Collaborative Care in Heart Failure Management in Kirkuk City- Iraq

Abstract

Background: In spite of advances toward the treatment of heart failure (HF), the number of hospital readmissions, and their associated health care costs are very high, and anticipated to rise exceptionally over the next decade that put an expanded load on the healthcare system. Drug-related problems (DRPs) is among the leading cause of hospital readmission. DRPs occur frequently upon discharge due to changes in medication regimen or suboptimal discharge instructions given to patients. Which can cause harm to patients. A need was therefore identified to update systems of care for HF. Recent policy is an increasing focus on delivering of intensive pharmaceutical care for these patients with the aim of reducing hospital admissions. Objective: To clarify the role of clinical pharmacist (CP) in the care of patients with HF in reducing rehospitalization, discrepancies, improving adherence and health related quality of life (QOL). Methods: A prospective, randomized, controlled intervention study was conducted on 100 patients with chronic HF were recruited from the Cardiac Clinic and Internal Medical Ward, at Azadi Teaching Hospital in Kirkuk City from March to August 2019. Patients have been randomized to two groups (50 patients per each) standard care (control) or standard care plus a follow-up program (intervention) that includes medication review and interview. Intervention participants are scheduled for a 30-min appointment with the clinical pharmacist, following their standard follow-up appointments at the Cardiac Clinic, patients in the intervention group were seen individually two times (baseline and follow-up) or as required over six weeks, at the Cardiac Clinic. An intervention agenda was set to check and manage any problems with prescribing and adherence. Additional information supplied on the discharge medication related to dose adjustments and discontinued medication. The data were analyzed using Statistical Package for the Social Sciences (SPSS) V.22, chi-square (X2) test, and t-test, and the significance level was < 0.05. Results: Ninety- three out of 100 patients were completed the study distributed between intervention and control group (47, 46) patients respectively. Both groups were nearly similar in term of age, gender, education level and smoking. After 6 weeks, there were statistically significant reductions in the following parameters of the intervention group; the total number of hospitalization (49 vs 23; P < 0.003), length of stay (LOS) (131 days’ vs 53 days; P < 0.002). Number of medication discrepancies, with a significant improvement in Patients' adherence (P value ≤ 0.01) and QOL. Regarding control group, no significant difference in the number of rehospitalization but the LOS there was a significant difference, a significant difference in one type of discrepancies, no improvement in adherence and QOL. Conclusions: The results of the current study revealed that pharmacists' contribution to providing medication care for patients with HF has a great impact on reducing the number of rehospitalization, LOS, medication discrepancies, and improving patient’s adherence and QOL, as well.