3.5.1.2 ASSESSMENT OF THE PATIENT COUNSELLING LEAFLET
• PILOT STUDY
The leaflet and questionnaire were tested in a pilot study conducted on a single day in May 1999 on thirty geriatric outpatients that were waiting to collect their medicine at the dispensary. The pilot study was conducted to allow for the refinement of the research instruments viz. the patient information leaflet and the questionnaire.
Problems were identified with the wording and clarity of the leaflet and the self- administered questionnaire, and these were amended. After finalizing the research instruments, they were distributed to geriatric outpatients in the actual study.
• ACTUAL STUDY
These geriatric outpatients were randomly selected whilst they were waiting to collect their medicines at the dispensary. Unlike the geriatric patients in phase 1 of the study, it was not feasible or necessary to apply the inclusion criteria listed in 3.2.3 to this sample population. The only inclusion criteria was that the patients had to be 65 years and over and this was verified by checking their receipts, which had their dates of birth. After explaining to the patients selected the purpose of the study, consent to take part in the study was obtained from them.
This study was conducted over a period of 2 days in June 1999 at the pharmacy outpatient's department of Addington hospital. 175 geriatric out- patients were selected randomly. Those who consented to take part in the study were given the leaflet, allowed 10 to 15 minutes to read it and were then asked to complete the short questionnaire.
3.5.2 PRESCRIBING GUIDELINES FOR GERIATRIC PATIENTS
It was considered that an educational intervention to improve prescribing in geriatric patients could potentially lead to fewer DRPs and drug-related admissions.
A guideline on prescribing for the elderly was compiled using the reference books e.g.
South African Medicines Formulary (SAMF), SA Essential Drug List (EDL), Basic and Clinical Pharmacology, Drug Interactions, Journal articles etc. The guideline in
Drug relllled problems among geriatric out-patients at a public sedor hospital: An intervention study 110
the form of a booklet comprises of the clinical drug interactions that were found to be the most common and implicated to cause undesirable effects in geriatrics. The prescribers were also advised on how to minimize the possibilities of adverse drug effect when treating geriatrics. (Appendix 4).
3.5.3 COUNSELLING OF DISCHARGE PATIENTS
The importance and benefits of counselling was established in phase 1 of this study.
Ideally, one of the most important intervention strategies would be to institute routine counseling of all patients at the hospital on their medicines. However, with the limitations of time, resources, staff and money in the public sector this is not practical or feasible. From previous literature and other studies, it was established that many hospital admissions of geriatric patients were due to DRPs, the greatest being non- compliance. Therefore, it was decided to implement counseling of in-patients in one of the medical wards as a pilot study. This was done according to the protocol on patient counseling of in-patients (Appendix 5).
Also supplying patients with a written counselling information at discharge IS a further means of overcoming DRPs like compliance (Appendix 5).
3.5.3.1 Discharge counselling information
Of concern is the low level of counselling of relatives, many of whom are involved in medication management in the home. The written patient-counselling discharge information can, therefore also serve as a source of information for caregivers. The patient-counseling leaflet provided written information on the new and current medicines to be read, once at home, by patients and by their relatives who helped with their medicines (Appendix 5).
In an intervention study by Woffindon in 1994, the importance of individualising the information provision to ensure that it is acceptable to the patient and appropriate to their needs and capabilities was emphasised. In addition, the information which patients wish to be given about their medicines must be considered. Information on
Drug reloted problems among geriatric out-patients at a public sector hospital: An intervention study
side effects how to use the medicine and the use of the medicine with other medicines , are among those aspects most highly rated.
General advice on prescription and medication management was given and prescribed medication was listed with full administration details. In addition, information on medication changes made in hospital, future medication needs and drug allergies were included. Finally, any problems in opening containers, measuring liquids and details of compliance aids used were noted.
3.5.4 DEVISING OF DRPs REPORTING SYSTEMS
One of the most common and potentially harmful or fatal DRPs is adverse drug reaction. This was a very common DRP in Phase 1 of the study. Documentation of ADRs should be according to the guidelines recommended by the national adverse drug event-monitoring centre (Appendix 6). However, in-house DRPs monitoring systems may be devised to monitor drug usage at a particular health institution, in this instance Addington hospital. A number of reporting systems are available. Using these an ADR reporting system was devised (Appendix 6). A medication error report (Appendix 7) was also devised for surveillance of errors in dispensing.
Drug related problems among geriatric out-patients at a public sector hospital: An intervention study