Specifically, she takes Losartan, Amlodipine, and Bendroflumethiazide for her blood pressure, along with a Salbutamol inhaler, Fluticasone & Salmeterol, and Prednisolone for her severe asthma.
A few days ago, after experiencing a throbbing headache, she visited her local community pharmacy and was given Diclofenac, a Non-Steroidal Anti-Inflammatory Drug (NSAID), to alleviate her pain. Prior to this recent medication, Mrs. Johnson was already taking seven different types of medications for her chronic conditions.
Due to its mechanism of action, Diclofenac Sodium exacerbated her asthma, resulting in severe shortness of breath and wheezing. She had to be taken to the Emergency Room (ER) and nebulised before getting some relief. If Mrs. Johnson's holistic healthcare, including her medications, had been evaluated at her local community pharmacy, she might have avoided the ER visit. This story highlights the importance of Medication Therapy Management.
The American Pharmacists Association defines Medication Therapy Management (MTM) as a specialised service or set of services aimed at optimising therapeutic outcomes for individual patients. This entails a thorough process to ensure a comprehensive review of patient medications, with the goal of enhancing patient care. In Ghana and across Africa, drug-related complications such as drug-drug interactions and medication non-adherence present significant public health challenges.
These issues have been linked to emergency department visits and hospitalisations in both district and teaching hospitals. A cross-sectional study at a university teaching hospital revealed that 61.2% of patients encountered moderate drug-drug interactions, while 12.8% experienced major interactions1.
The incidence of drug-drug interactions exceeds 80% for patients like Mrs. Johnson, who are taking 7 or more medications. These complications lead to a high rate of hospitalisations, further increasing healthcare costs and putting additional strain on the already limited healthcare budget.
To reduce the incidence of drug-related complications, implementing Medication Therapy Management at local community pharmacies, which serve as the primary point of contact for healthcare needs in Ghana, is one viable strategy.
Putting Theory to Practice
Although Medication Therapy Management (MTM) has been an established practice in pharmacies across Western countries, community and retail chain pharmacies in developing nations like Ghana have yet to embrace it. Mr. Prince Boateng, a Superintendent Pharmacist at Sanor Chemists in Accra, began implementing MTM several years ago. Mr. Boateng’s’ family managed various chronic conditions with different medications, and he assisted them in organising their drug regimens.
This intervention improved adherence and decreased hospitalisations. Recognising its potential, he believed that such a practice could be transformative for patients at his pharmacy. He expressed his enthusiasm by stating, “I had observed the complications arising from inadequate MTM and decided to introduce this approach at Sanor Chemists. We follow a straightforward four-step process: Problem Identification & Impact, Development of Standard Operating Procedures (SOPs), Stakeholder Alignment, and Implementation & Measurement of Results.” He emphasized the importance of aligning with pharmacy stakeholders for successful MTM. “Securing the support of colleagues and establishing tools and SOPs is essential,” Prince noted.
“At Sanor, our MTM process includes three core components: Current or Past Medication Therapy Review, Medication Action Plan, and Documentation and Follow-Up.”
This ensures that every patient has a health record that pharmacists can visit to manage their medications. Since the Implementation at Sanor, approximately 150 patients have benefited from the service, and this has also added a line of revenue for the company.
Impact to Pharmacy Practice
Mr. Boateng has shared the MTM success at various fora including the Pharmacy Connect Group and this has led to adoption in about 25 pharmacies across the country.
“This is the future of pharmacy practice in Ghana. Mr. Prince Boateng and his team at Sanor Chemists have been a trailblazer in implementing MTM and we have seen tremendous new patient inbound of about 20% and clinical outcomes improvement since we implemented it here too”- Arnold Agyei, Head of Wholesales at Ernest Chemists Ghana Ltd.
Joseph Agyapong from Tema Clinic Pharmacy stated, "As pharmacists, it is important for us to be close to our patients. We need to guide them toward optimal health outcomes, and MTM is one method to achieve this. Many thanks to Mr. Boateng and the team for implementing this concept in Ghana. Now, Pharmacists can enable their patients to manage their health. This approach has also increased our revenues by 15%, with continued growth each quarter. Additionally, we have built strong relationships with our patients, who continue to choose us for their healthcare needs."
"This concept has genuinely transformed lives. Healthcare is a continuous journey, and we are honored to be part of it with patients through Medication Therapy Management. We've seen a significant increase in our patients' understanding of their medications, a 10% reduction in the frequency of adverse events, and overall, our patients are very satisfied. We extend our gratitude to the pharmacist team at Sanor, led by Mr. Boateng, for bringing this concept to us." – Baah-Akyeamfour E., Head of Pharmaceutical Services at Unichem Ghana Ltd.
Managing patients’ medications well has immense benefits including:
· Adherence to therapy to improve patient outcomes
· Reduced medication side effects
· Personalized patient care
· Improved medication knowledge
The productivity of any nation hinges on the health and well-being of its citizens. One effective approach to enhancing Primary Health care and preventing complications like those experienced by Mrs. Johnson is through medication therapy management. It is imperative to back initiatives that aim to expand MTM across the country.
References
1. Bhagavathula AS, Berhanie A, Tigistu H, Abraham Y, Getachew Y, Khan TM, Unakal C. Prevalence of potential drug-drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia. Asian Pac J Trop Biomed. 2014 May;4(Suppl 1):S204-8. doi: 10.12980/APJTB.4.2014C1172. PMID: 25183081; PMCID: PMC4025339.