Xin Yun Chua

Pharmacy Department, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia

An Evaluation of Medication Adherence to Tyrosine Kinase Inhibitors Among Chronic Myeloid Leukemia Patients Underwent Medication Therapy Adherence Clinic in a Malaysian Tertiary Hospital

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    Abstract

    Introduction: The treatment of chronic phase chronic myeloid leukemia (CML) has changed dramatically within the last two decades with the emergence of tyrosine kinase inhibitors (TKI). Treatment adherence to long-term TKI is pivotal to improving clinical outcomes in CML patients. Objective: To evaluate medication adherence to TKI and contributory variables affecting medication adherence among CML patients underwent Medication Therapy Adherence Clinic (MTAC). Method: This was a single-centre cross-sectional study conducted between January and December 2021. Malaysia Medication Adherence Assessment Tool (MyMAAT) was employed to assess medication adherence among CML MTAC patients. Descriptive statistics were used to summarise adherence information. Fisher’s exact test was performed to examine relationships between TKI adherence level, demographic and clinical variables. Result: Records of 41 patients (61% male, 39% female) at average age of 51 years old (range = 26 to 75) were analysed. They had been taking imatinib (48.8%) and nilotinib (51.2%) for an average of 6.3 years (range = 17 days to 18 years). Overall, 90% of the patients were adherent (MyMAAT score ≥ 54) to their TKI treatment (95% of patients on imatinib, 86% of patients on nilotinib). Medication adherence to TKI was not significantly influenced by demographic variables (i.e. age, gender) and clinical variables (i.e. years on TKI, number of TKI pills per day, type of TKI therapy). Conclusion: Majority of the CML MTAC patients (90%) were adherent to their TKI therapy. Adherence scores were not affected by the demographics and clinical variables investigated in this study. This affirms the role of pharmacists in implementing an individualised and comprehensive intervention strategy.

    An Evaluation of Interventions by Clinical Pharmacists in a Tertiary Hospital

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      Abstract

      Introduction:  Problems with medication therapy are a major concern in health care because of the associated increase in morbidity, mortality and increased cost of treatment. Clinical pharmacy services are well established in developed countries such as the United States and has been reported to reduce adverse drug events, medication errors, patient’s length of stay, mortality rates and costs. Clinical pharmacists proactively ensure rational medication use, avoiding medication errors at point of prescribing. They participate in ward rounds, communicate with the team in the wards, interview patients, perform medication reconciliation, provide counselling, therapeutic drug monitoring, antibiotic stewardship, discharge screening and follow ups. Any discrepancy or problems detected will be conveyed to the relevant team member for correction.  Objective: To describe and evaluate the interventions performed by clinical pharmacists in a tertiary teaching hospital in Malaysia. Method: A clinical pharmacy observational retrospective study was conducted between January and December 2019. Fourteen clinical pharmacists were assigned to respective wards in the medical, surgery and intensive care units to provide pharmaceutical care. All interventions performed in the wards were documented systematically. Result: A total of 3345 interventions were recorded. The most frequent interventions were on rational drug therapy (n = 1456, 43.5%), followed by corrections made on prescription (n = 1349, 40.3%) and changes in dosage and frequency (n = 540, 16.2%).  The majority of suggestions (n = 3264, 97.6%) have been accepted. Conclusion: To our knowledge, this is the first study reporting clinical pharmacist interventions in a teaching hospital in Malaysia. The involvement of clinical pharmacist in the wards contributed to the optimisation of pharmacotherapy, safety and better patients’ outcomes. There was good inter-professional collaboration at the ward level.