The Outcome of Physician and Pharmacist Collaboration on Re-hospitalization

Rate among Congestive Cardiac Failure (CCF) Patients in Kulim Hospital

M. Hafizi1, K. Fazli1, R. Fadhli1

1 Department of Pharmacy, Kulim Hospital.

Background: Heart failure is an important cause of hospitalization accounting for

about 10% of all medical admissions in Malaysia. Pharmacists have a role to
intervene on the appropriateness of heart failure therapy, drugs and dosage
optimization, as well as to assess patient’s compliance. Objective: To evaluate the
outcome of involving pharmacist as a part of medical team on re-hospitalisation of
the congestive cardiac failure patients. Methods: Prospective 12 months study in
Medical Outpatient Department (MOPD), Medical Ward and Pharmacy, Kulim
Hospital was conducted. Patients diagnosed with congestive cardiac failure (ejection
fraction <40%) undergoing follow-up in MOPD for at least 6 months were recruited.
Patients were randomized into INTERVENTION arm and CONTROL arm. During
each visit of every 3 months, patients in INTERVENTION arm received compliance
assessment (Morisky Scale), counselling and pharmacotherapy review, then
appropriate recommendation given to physicians. Otherwise, patients in CONTROL
arm only received compliance assessment and regular care. Defaulted patients were
follow-up through Home Medication Review (HMR) programme and telemonitoring.
Results: Baseline characteristics were quite similar for both group. A total of 100
CCF patients were studied: 48 patients in INTERVENTION arm and 52 patients in
CONTROL arm. At the end of study, mean admission rate per patient is 0.29±0.58 in
INTERVENTION arm vs 2.28±0.85 in CONTROL arm (p< 0.05).77.10% patients in
the INTERVENTION arm had no admission during follow-up vs only 25% patients in
the CONTROL arm (p< 0.05). Patients’ compliance evaluated by using Morisky
Scale showed significant improvement from 2.104±0.555 to 0.1875±0.490 in the
INTERVENTION arm compared to the patient’s compliance in CONTROL arm which
showed no improvement (p< 0.05). Conclusions: Pharmacist and physician
collaboration had contributed to a significant improvement in reducing the rate of re-
hospitalization among CCF patients through proper interventions and improved
patients compliance toward the medication.