CLINICAL PHARMACIST INTERVENTIONS IN DRUG THERAPY IN PATIENTS WITH DIABETES MELLITUS AND HYPERTENSION IN A UNIVERSITY TEACHING HOSPITAL

Introduction: Drug related problems occur commonly in patients who often receive polypharmacy with multiple co-morbid conditions. This constitutes a major health problem because of their negative consequences with increased morbidity and mortality. Aims and Objectives: The aim of the study was to assess the impact of clinical pharmacist interventions in drug therapy in hospitalized diabetes mellitus patients with hypertension. Methodology: A Prospective interventional study was carried out in the medicine wards of a tertiary care teaching hospital over a period of 10 months from September 2013 to June 2014. The drug therapy details of the patients were collected from inpatient case records. Clinical pharmacist reviewed the drug therapy, identified the drug related problems during ward rounds and discussed with the physicians and suitable suggestions was provided which had been documented. Results: A total of 147 drug therapy problems were identified from 111 patient case records. The number of drug related problems was predominant in males than females. Drug related problems were commonly seen in patients aged between 61-80 years of age. The most common drug related problems was found to be improper drug selection (22.44%) followed by drug use without indication (19.04%). The most frequent suggestions by the clinical pharmacist were on cessation of drug (25.17%). The acceptance rate of suggestions and the changes in drug therapy was found to be high (52.38%). The level of significance of drug related problems was found to be moderate significance in grade. Conclusion: Involvement of clinical pharmacist as a member of healthcare team during the ward rounds in hospitalized patients with diabetes mellitus helps in identification and prevention of drug related problems which will help to rationalise the drug therapy, achieve better therapeutic outcomes and improved quality of patient care.