Drug-related Problems in Diabetes and Transplant Patients: an Observational Study with Home Visits

Objectives: To get insight into the medication management of diabetes type 2 (DM) as well as solid organ transplant (Tx) patients and to analyse drug-related problems (DRPs) in order to explore opportunities for the provision of pharmaceutical care.

Setting: Seventy-nine Swiss community pharmacies offering internships for pharmacy students.

Methods: Diabetes and transplant patients were recruited in community pharmacies and were interviewed at home by fifth-year pharmacy students who were supervised by a trained investigator, using a specific interview guide developed for this study.

Main Outcome Measure: Pattern and frequency of DRPs and pattern of medication management.

Results: In total, 22 (Tx patients) and 54 (DM patients) home visits were carried out. Mean age of visited patients was 71.4 ± 8.1 years (DM) and 52.6 ± 13.8 years (Tx). Overall, 37.0% (DM) and 50.0% (Tx) of participants were female. We identified 7.4 ± 2.4 (mean ± SD) DRPs per visited patient, with considerable differences between Tx and DM patients (6.3 ± 1.7 vs. 7.8 ± 2.5). The most frequent DRPs were risk for non-adherence (DM: 61.1%; Tx: 77.3%), confusion of generic and trade names (DM: 74.1%; Tx: 27.3%), hoarding of over-the-counter medicines (DM: 48.1%; Tx: 4.5%) and prescription-only medicines (DM: 37.0%; Tx: 36.4%), gaps in knowledge about potential interactions (DM: 61.1%; Tx: 18.2%) and purpose of drugs (DM: 48.1%; Tx: 36.4%). Mean (SD) duration of the visits was 51.7 ± 21.4 min.

Conclusion: Visiting Tx and DM patients in their homes allowed the identification of a wide range of opportunities for pharmaceutical care as well as specific DRPs which most probably would have escaped a medication review in the pharmacy.