Implementation and Evaluation of Pharmaceutical Care Service for Refill Clinic at Ramathibodi Hospital

Abstract

A pharmaceutical care service (PCS) was initiated at refill clinic, Ramathibodi Hospital. The objective of this study was to implement and evaluate PCS program using Donabedian's (Structure-Process-Outcome) conceptualization. The study was divided into 4 phases; 1) project initiation, 2) preparation, 3) implementation, and 4) program assessment.

The project was approved in March 2007. In the preparation phase, all structures, work place, facilities (such as computer software), pharmacists, and work process were planned for the provision of PCS. During the one-year implementation phase (July 2007 to June 2008), a total of 2,155 patients with chronic diseases and stable condition were recruited to receive PCS together with refill prescribing process. The pharmacists recorded prescription data, provided pharmaceutical care services to 2,809 encounters, and gave 3,345 refill prescriptions. Between October 2007 and June 2008, 1,545 of the 2,548 encounters (60.64%) were returned for refills. Of these, 1,111 encounters (71.91%) were refilled with PCS process. For clinical outcomes, pharmacists interviewed 154 patients and identified 72 DTPs, 61.11% of which were non-compliance. When interventions are recommended for the problems, physicians accepted 86.36% of pharmacists' recommendations. For economic outcomes, benefit as drug cost saving (from duplicates and oversupplies) was 419,214.48 Baht and the benefit to cost ratio was 2.45 : 1. For humanistic outcomes, 95.2% of the respondents recommended their relatives or friends with problems or doubts about medication to receive PCS.

In conclusion, PCS could reduce DRPs and save drug cost. It is recommended that the program should be expanded to cover other groups of patients so as to achieve more efficient use of health resources.