The patient’s case was perplexing. He had enough diabetes medicine to last him for more than six months, even though pharmacies do not normally dispense more than three months’ worth of medication.

After many questions, the pharmacist found out that the 69-year-old occasionally forgot to take his medication.

“The pharmacist realised that the patient just kept collecting the medicine after every visit to his doctor,” said Ms Ong Wan Chee, Pharmacist, Pharmacy Department, Singapore General Hospital (SGH), a member of the SingHealth group. “He did not understand what medication he had to take, and he also did not take the amount that he was prescribed.”

Unsurprisingly, his test results showed that his diabetes was not under control. He also suffered from long-term hypertension and had fluctuating blood pressure levels.

Such cases often arise when patients take many different kinds of medicine for a variety of diseases. There are also patients who see various doctors for different complaints, but end up being given similar drugs.

To help patients like the old man, SGH started a Medication Management Service last year. The service is operated by pharmacists who make sure that patients understand how to take their medicine.

The pharmacists review the patients’ medication to ensure they have not been prescribed duplicate drugs, and also check for the possibility of adverse reactions between the drugs.

In the case of the 69-year-old diabetes patient, he was given a chart prepared by his pharmacist to document his blood sugar levels. The pharmacist explained the medication he had to take and taught him to monitor his blood pressure.

After the consultation, the patient’s blood sugar levels improved. This allowed his doctor to adjust the dosage of his medication. A few months later, the patient’s diabetes was under control and he no longer faced the risks that required the attention of an acute-care hospital.

Pharmacists play a bigger role in patient care

The case is a good example of how pharmacists can contribute to better care for patients, said Ms Ong.

Pharmacists are often seen as people who passively dispense medicine. In reality, they are trained to do a lot more. They are qualified to counsel and educate patients and to help them take charge of their health.

The Medical Management Service thus allows pharmacists to play a bigger role. For example, when a patient does not tell his doctor that he has not been taking his medication, there is a risk that he would be asked to take a higher dose because his doctor may think that his condition is worsening.

“So, we try to establish a relationship with the patients,” said Ms Ong. “We want them to feel comfortable enough to tell us why they’re not taking their medication.”

When patients gain a better understanding of the drugs they are taking, they are better able to manage their diseases. And this could help to reduce the number of people admitted to hospital for medication-related problems.

A recent review of SGH renal transplant patients found that 40 out of 100 were not taking their medication correctly. Some were not taking their medication, while others took less than their prescribed dose.

The study, carried out between January and May last year, also showed that 12 per cent of the patients had adverse reactions to their medication.

Ref: S13