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The School of Pharmacy MEDICATION-RELATED PROBLEMS (MRPs) IN ASIAN PATIENTS WHO HAVE CHRONIC DISEASES – RESPIRATORY, DIABETES

, CARDIOVASCULAR AND RHEUMATOID DISEASE

KIRTI BILLKHU1, SORAYA DHILLON1, SATNAM BUTTER2
1School

of Pharmacy, University of Hertfordshire, College Lane Campus, Hatfield, Hertfordshire, AL10 9AB, UK

2LPC

Pharmaceuticals Ltd., 30 Chaul End Lane, Luton, Bedfordshire, LU4 8EZ

Introduction & Aim
Chronic diseases are life-long conditions with slow progression and are responsible for 60% of all deaths worldwide (World Health Organisation, 2009). Poor management can lead to a variety of medication-related problems (MRPs) which further result in poor health outcomes, increased use of National Health Service (NHS) resources, unnecessary NHS costs, and increased hospital admissions. South Asian patients face barriers to care, which can contribute to MRPs and therefore should be targeted in order to identify and reduce these problems and optimise pharmaceutical care and medicines management. The study aimed to explore MRPs experienced by South Asian patients by (1) identifying and (2) categorising MRPs in those suffering from chronic illness, using Gordon’s MRP tool (Gordon et al, 2005); (3) determining patients’ satisfaction and beliefs about medicines using SIMS (Horne, Hankins and Jenkins, 2001); (4) reporting barriers, issues and problems faced regarding access to pharmaceutical care; and (5) making recommendations to improve pharmaceutical care.

Method
• Both a qualitative and quantitative approach was taken to identify MRPs in South Asians aged between 18 and 80 years, with a chronic condition. • Patients were recruited using a direct approach or via interrogation of the patient medical records (PMRs) at community pharmacies in Dallow Road, Hockwell Ring and Bury Park, Luton. A clear outline of the study was provided and anonymity was ensured. • Informed consent was taken and patients were interviewed in private consultation rooms using two validated tools. Field notes were made to support the interview. The semi-structured interviews were audio-recorded, translated and then transcribed. • Transcripts were thematically analysed and the themes were compared to existing an MRPs categorisation (Gordon et al, 2005). Quantitative analysis was performed using Excel to report descriptive statistics. • Ethical approval was sought and approved by NHS ethics.
Figure 1: Asian patient with diabetes [Source: Diabetes UK, 2009]

Results & Discussion
Of the 45 patients eligible, 12 (26.7%) were recruited. Seven (58%) male and five (42%) female, age range 39-72 years (average of 58 years) were on at least 2 medications for their chronic condition. The majority were born in Pakistan (50%) or India (25%) and self-classified as Indian (42%) and Pakistani (34%). Almost all (83.3%) had comorbidities. None were able to identify the names of all their prescribed medicines, but were able to describe them. High adherence to dosage regimens was reported where 10 patients (83%) said they’d never altered their dosage, though some patients (58.3%) did forget to take their medicines. Figure 2 highlights the common themes of MRPs experienced. Despite reporting side effects, adherence was high; patients exhibited “blind belief” – a concept where patients do not questions decisions made – and refused the offer of more information (in spite of SIMS demonstrating that patients were dissatisfied with information received [table 1]). Patients also showed a lack of understanding, indicating that medication-taking behaviours were more an “act of obedience” and trust in their GP, rather than understanding of their condition. This puts a burden on health; South Asians are already faced with health inequalities and additional barriers to care, and so tailoring pharmaceutical care is to meet their needs is of utmost importance.
Table 1: the satisfaction with information about medicines

Intentional noncompliance Negative outlook on health Side effects

Unintentional noncompliance

Poor access to services

Cultural and religious influences

MRPs

“Blind belief”

SIMS total satisfaction rating SIMS action and usage SIMS potential problems of medication (out of 17) (out of 9) (out of 8) 6.00 ±2.59 4.17 ±1.90 1.83 ±1.11

Run out Supply of medicine Insufficient quality of information provided

Poor understanding on services available

Lack of trust in healthcare system Lack of education on condition

Conclusion
Pharmaceutical care must be tailored to accommodate for the additional barriers to care South Asian patients encounter. Education is significant in ensuring good understanding, and so its delivery may need to be modified so patients are able to comprehend it. Health professionals need to avoid stereotyping patients and focus on meeting their needs so that poor health outcomes, rates of hospitalisation and unnecessary costs to the NHS can be minimised.

Figure 2: medication-related problems identified

Acknowledgement
The authors would like to thank the patients, the staff at the pharmacies, Majid Ali, Nazmeen Malik, Tehmina Rashid and Osmaan Siddiq for their contributions.

References
Diabetes UK. (2009). [Image] Retrieved 11th January 2010, from http://www.diabetes.org.uk/About_us/News_Landing_Page/Diabetes-UK-pinpoints-key-diabetes-research-in-SouthAsianpeople/ Gordon, K., Smith, F., and Dhillon, S. (2005). The development and validation of a screening tool for the identification of patients experiencing medication-related problems. International Journal of Pharmacy Practice, 13 (3), 187-193. Horne, R., Hankins, M., and Jenkins, R. (2001). The satisfaction with information about medicines scale (SIMS): a new measurement tool for audit and research. Quality in Health Care, 10 (3), 135-140. World Health Organisation. (2009a). Chronic diseases. World Health Organisation. Retrieved December 6th 2009, from http://www.who.int/topics/chronic_diseases/en/.