title: Improving medication safety and diabetes management in Hong Kong: a multidisciplinary approach.
abstract: BACKGROUND
  Patients with diabetes often require complex medication regimens. The positive impact of pharmacists on improving diabetes management or its co-morbidities has been recognised worldwide. This study aimed to characterise drug-related problems among diabetic patients in Hong Kong and their clinical significance, and to explore the role of pharmacists in the multidisciplinary diabetes management team by evaluating the outcome of their clinical interventions.
  
  
  METHODS
  An observational study was conducted at the Diabetes Clinic of a public hospital in Hong Kong from October 2012 to March 2014. Following weekly screening, and prior to the doctor's consultation, selected high-risk patients were interviewed by a pharmacist for medication reconciliation and review. Drug-related problems were identified and documented by the pharmacist who presented clinical recommendations to doctors to optimise a patient's drug regimen and resolve or prevent potential drug-related problems.
  
  
  RESULTS
  A total of 522 patients were analysed and 417 drug-related problems were identified. The incidence of patients with drug-related problems was 62.8% with a mean of 0.9 (standard deviation, 0.6) drug-related problems per patient. The most common categories of drug-related problems were associated with dosing (43.9%), drug choice (17.3%), and non-allergic adverse reactions (15.6%). Drugs most frequently involved targeted the endocrine or cardiovascular system. The majority (71.9%) of drug-related problems were of moderate clinical significance and 28.1% were considered minor problems. Drug-related problems were totally solved (50.1%) and partially solved (11.0%) by doctors' acceptance of pharmacist recommendations, or received acknowledgement from doctors (5.5%).
  
  
  CONCLUSIONS
  Pharmacists, in collaboration with the multidisciplinary team, demonstrated a positive impact by identifying, resolving, and preventing drug-related problems in patients with diabetes. Further plans for sustaining pharmacy service in the Diabetes Clinic would enable further studies to explore the long-term impact of pharmacists in improving patients' clinical outcomes in diabetes management.
authors.affiliation: Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: A Ys
authors.initials: AY
authors.lastname: Chung
authors.affiliation: Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: S
authors.initials: S
authors.lastname: Anand
authors.affiliation: Research Department of Practice and Policy, School of Pharmacy, University College London, United Kingdom.
authors.forename: I Ck
authors.initials: IC
authors.lastname: Wong
authors.affiliation: Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: K Cb
authors.initials: KC
authors.lastname: Tan
authors.affiliation: Department of Pharmacy, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: C Ff
authors.initials: CF
authors.lastname: Wong
authors.affiliation: Department of Pharmacy, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: W Cm
authors.initials: WC
authors.lastname: Chui
authors.affiliation: Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: E W
authors.initials: EW
authors.lastname: Chan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000188:drug therapy; D019468:Disease Management; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D059065:Medication Reconciliation; D010348:Patient Care Team; D010593:Pharmaceutical Services / Q000592:standards*; D010595:Pharmacists; D024382:Professional Role
keywords: Diabetes mellitus; Disease management; Pharmacists