Through the Singapore General Hospital (SGH) CO-MED initiative, SingHealth pharmacists, community nurses and partners are coming together to support effective and safe medication use in the community.

Patients and their caregivers often face medication-related concerns when they are prescribed different types of medication to manage chronic health conditions. While some would seek clarification through the outpatient pharmacy hotline, others would self-adjust or discontinue medication altogether, jeopardising patient safety and health outcomes.

To improve medication management within the community, SingHealth launched the CO-management of MEDication in the community (CO-MED) in January 2023.

CO-MED is a person-centred, transdisciplinary network that provides timely medication-related assistance to patients in the community and their caregivers. The idea was conceptualised and piloted in 2019 after discussions at ESTHER Cafés, which are sharing sessions for patients and care providers to discuss improvements to the patient care experiences.  A collaborative effort led by the pharmacy profession to bolster Population Health, CO-MED has established clear referral channels between community healthcare providers and pharmacists for medication-related management.

Challenges faced with medication management

SGH Senior Staff Nurse (Community Nurse) Ms Ng Xiang Ling and Montfort Care Senior Staff Nurse Mr Rafiuddin Bin Halim welcomed the CO-MED initiative to reduce the occurrence of medication-related harms in the community.

Stationed in the residential areas to support seniors with chronic health conditions, Ms Ng has seen first-hand the host of challenges that elderly with complex medication regimens face. She noted that patients are often confused by the various brand names for the same medication, or may adhere to multiple prescriptions from different doctors without being aware of potential negative drug interactions.

Mr Rafiuddin noted that as patient's medication regime is personal, it is important for community health providers to have an in-depth understanding of one's medical history to be able to assist appropriately. "For us to help, we need to understand why a client is on a particular medication in order to assess if they should continue with it to prevent unnecessary complications," he said.

Teamwork makes the meds work

This is where CO-MED comes in – by establishing active and collaborative links between community partners and pharmacists.

Ms Kathleen Yik, Senior Pharmacist at SGH, explained that through CO-MED, outpatient pharmacists will proactively alert community partners of patients who may need monitoring—such as those with complex medication regimens or who have started on new medications.

Community partners can then update the pharmacists immediately if the patient faces any issues, allowing for timely intervention. For example, they might adjust the patient's dosage, discontinue the course of medication, or even have a tele-consult to walk the patient through their concerns.

"Through this close inter-professional collaboration, we hope to improve medication adherence and medication literacy in the community," Ms Yik said.

Importantly, CO-MED enables healthcare professionals to learn from one another. "The Pharmacy Department has conducted six to eight sharing sessions a year on medication-related topics for community nurses, including administration techniques and potential drug-drug or drug-food interactions," Ms Yik said.

Community health providers like Mr Rafiuddin and Ms Ng are then able to leverage their knowledge and engage patients in educational outreach programmes, thereby playing a more active role in patient education.

Likewise, pharmacists better understand the perspectives of community stakeholders through these sharing sessions. Mr Tang Ee Fhong, Senior Pharmacist at SGH, added, "I gain insights into the social issues plaguing patients, that may then in turn affect their medication adherence and disease control. Understanding some of the practical aspects of medication use that concern patients allows me to better tailor my counselling and overall care for them."

Looking to the future

Today, CO-MED partners include SingHealth pharmacies, SingHealth community nurses, SGH Hospital to Home programme nurses, Montfort Care, Thye Hua Kwan Moral Charities, St Andrew's Nursing Home, Singapore Amalgamated Services Co-operative Organisation (SASCO) Senior Citizens Home and SGH's Division of Population Health and Integrated Care.  

As the initiative continues to evolve, Ms Yik, Mr Rafiuddin and Ms Ng are optimistic that it will boost the quality of continuous care from hospitals into community settings.

"I want to empower residents for better self-care. I hope we can establish an integrated, comprehensive medication management system to optimise the outcome of residents and help them stay well in the community," Ms Ng concluded.