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Tzu Chi Med J 2004 � 16 � No. 3 �� ! NUP

Assessment of a Pharmacy-Based Drug Use Follow-Up Program for Am-

bulatory Patients with Chronic Disease

Mei-Hua Chuang, Yuh-Feng Wang1, Chin-Lon Lin

2, Chi-Hui Lee

Department of Pharmacy, Nuclear Medicine1, Division of Cardiology, Department of Medicine2, Buddhist Dalin Tzu Chi

General Hospital, Chiayi, Taiwan

ABSTRACTObjective: Most patients with chronic diseases have a series of common characteristics that are as follows: advancedage, lower education level, comorbidity, a requirement for multiple drug therapy and a requirement for long-term care.Unfortunately, the compliance and self-monitoring ability of these patients for disease and for adverse drug reactionsare usually poor and do not achieve the most optimal therapeutic outcome. Another concern is that some patients needto take medications with narrow therapeutic index. So, if patients are treated long term, but can not be followed upappropriately, they may give up their therapy due to the occurrence of adverse drug reactions or a subtherapeuticoutcome. These phenomena not only defeat the aim of the patient's treatment directly, but also increases the costs ofhealth care and thus on society indirectly. The objective of this study was to attempt to improve drug therapeuticoutcomes by providing pharmacy-based drug use follow-up services for ambulatory patients with chronic disease.Materials and Methods: Five different treatment groups (made up of carbamazepine, digoxin, methotrexate, phenytoin,and theophylline) for a total 500 patients were selected from outpatient clinics. Each group was further divided intoeither a control or an experimental group. The impact of ambulatory pharmacy-based education and the monitoring ofintervention was assessed through a one-year telephone follow-up interview project. Results: The rates of expectedclinic returns, compliance, and patient's satisfaction for the experimental group were higher than for the control group.Conclusion: The delivery of care to patients with chronic disease is a complex process that can be improved by usinga team of health care professionals with a variety of skills. The pharmacist's contribution to patient care througheducation and monitoring, and in particular through sharing responsibility for drug therapy, is an approach that can beadvocated as a way to optimize drug therapy and improve patients' health-related quality of life. (Tzu Chi Med J2004; 16:173-183)

Key words: chronic disease, compliance, adverse drug reaction, telephone follow-up interview

Received: July 18, 2003, Revised: August 20, 2003, Accepted: November 24, 2003Address reprint requests and correspondence to: RPh. Mei-Hua Chuang, Department of Pharmacy, Buddhist Dalin Tzu ChiGeneral Hospital, 2, Min Sheng Road, Dalin, Chiayi, Taiwan