Authors (including presenting author) :
YANG KT(1), CHAN WYM(1), MAK CK(1), MAK LKK(1), YEUNG CK(2), CHEUNG YS(2),NG CK(3) CHAN SP(3)
Affiliation :
(1) Department of Pharmacy, Tseung Kwan O Hospital (2) Department of Medicine, Tseung Kwan O Hospital (3) Department of Orthopedics & Traumatology, Tseung Kwan O Hospital
Introduction :
Osteoporosis has become one of the most prevalent conditions that are associated with great medical and socioeconomic burden in Hong Kong. In Dec 2022, clinical pharmacists in Tseung Kwan O Hospital collaborated with doctors and osteoporosis nurses to launch the first pharmacist-led osteoporosis ambulatory care clinic among HA hospitals.
Objectives :
(1) To improve patient care in managing osteoporosis through an interdisciplinary care approach
(2) To provide safe and structured management program for patients who are on osteoporosis drug therapy especially oral bisphosphonates
(3) To provide targeted education and counselling services to patients enhancing drug adherence and monitoring potential side effects of therapy
Methodology :
Doctors from medical and orthopedic departments would refer patients who were 1) newly started on oral bisphosphates or 2) stable patients on lengthy prescription of osteoporosis treatment e.g., bisphosphonates / SERMS where regular monitoring is desired by doctors/nurses to pharmacist clinic.
Patients were cared via a shared-care approach, with alternate doctor-nurse and pharmacist consultations. Pharmacists would assess patients’ compliance, potential adverse side effects of therapy, potential drug-drug interaction with other prescriptions, give advice on lifestyle modification and arrange appropriate monitoring e.g., arrange blood tests and subsequent DEXA scan.
Medications will be refilled on site until the next follow-up visit. If patients’ conditions require prompt medical attention, pharmacists would seek on-site support from doctors or nurses.
Result & Outcome :
As of Oct 2023, 138 face-to-face consultations were conducted. A total of 33 drug related problems (DRPs) were identified and managed by pharmacists.
Most DRPs were related to patient compliance issues (18, 54.5%), inadequate drug supply on prescription (7, 21.2%) and adverse drug reaction/ drug allergy (3,9.1%). 2 patients were instructed to withhold bisphosphonate after consulting orthopedic doctors.
The acceptance rate of pharmacists’ suggestions by doctors was 100%. Feedback from medical and orthopedic department was positive. It demonstrated pharmacists played an essential role as part of the interdisciplinary team in managing osteoporosis.
Pharmacist Osteoporosis Clinic effectively enhanced service quality by close monitoring, enhancing drug compliance and early identification of drug related problems. Service could potentially extend doctors follow-up interval.
Future directions under exploration include subcutaneous injection treatment e.g. denosumab,repeating drug prescriptions and explaining DEXA scan results.
