Some hospitals have set up medication review services for patients that have questions on medication and dosage. JOAN CHEW reports
Mr Rajan Veerasamy, 84, suffers from over 10 medical conditions, including anaemia and depression.
He has to take six different types of medicine, but he does not know when or how he should be taking them.
His wife and sole caregiver, Mrs Lakshmi Veerasamy, 65, also has difficulty keeping tabs on his medication.
These are from two hospitals – Tan Tock Seng Hospital (TTSH) and Singapore General Hospital – which he visits to manage his diabetes mellitus, urinary tract infection and high cholesterol.
His wife cannot read the English medicine labels and even though there are symbols drawn on them like a sun and a moon to show the required frequency, she sometimes forgets to refer to them.
Speaking through a case manager from the Thye Hua Kwan Moral Society, Mrs Veerasamy said in Tamil: “Initially, I was fearful of giving him his medication as the dosage required was all very confusing to me.”
The elderly couple, who have no children, received a helping hand from Thye Hua Kwan Moral Society last November. His case was referred from TTSH.
Now Mr Veerasamy’s medication is sent by the society to the Khoo Teck Puat Hospital’s (KTPH) pharmacy once a month so daily doses can be packed into a special dispenser. His wife can now give him the correct doses at the appropriate times.
The case manager from the society, Ms Shanti Devi, 38, also visits him regularly.
The trained nurse checks on whether he is taking the correct doses at the right time. She also teaches the couple about the types of medicine and their possible side effects.
Other hospitals have another service that also helps patients who have questions on medication and dosage.
They can approach medication review services in hospitals and polyclinics if they are not sure of the medicines they should take and when. Correct dosage is also a problem to them at times.
Since March, Changi General Hospital (CGH) has introduced a medication therapy management (MTM) service at its outpatient pharmacy.
The pharmacist reviews all of a patient’s medication to help him understand, organise and manage them better.
Some patients are referred there by doctors. However, this service is also open to others by appointment.
A CGH spokesman said that the service is beneficial to patients who receive medication from more than one doctor, take five or more long-term medicines or for those who have new or complex medication regimens.
Patients using the service are required to bring along all their current and old medicines, including over-the-counter medication and herbal and vitamin supplements.
The TTSH medication reconciliation programme, which began as a pilot project in 2007, was rolled out to the hospital’s inpatients last December.
A pharmacist meets the patients or family members to review medication history. This service is also available at the outpatient pharmacy.
Dr Roland Boey, senior consultant from the department of general medicine at TTSH, noted that a patient’s incomplete medication history is often a stumbling block to healthcare workers.
Patients may be prescribed similar medicines which are sold under different brand names by different doctors, giving rise to unintended double-dosing.
Sharing medical records
In April 2004, the Electronic Medical Record Exchange (EMRX) was introduced by the Health Ministry and the two public healthcare clusters – Singapore Health Services and National Healthcare Group – to share electronic medical records across all public hospitals and polyclinics in Singapore.
These records include information on the diagnoses, laboratory test results and prescribed medication.
However, when patients visit general practitioners and private hospitals, their records are not captured by EMRX.
Doctors will then have to gather the information from patients themselves. It is because some of these patients have difficulties in naming their medication that hospitals launched this initiative.
Ms Goh Lay Hong, principal pharmacist at TTSH’s inpatient pharmacy, said that this system saves doctors from having to retrieve patient records from different sources. It makes for faster decision-making in treatment.
One patient who has reaped the benefits of a medication review service is 63-year-old Tan Kay Song.
He learnt from a session at the TTSH outpatient pharmacy in January that he had been taking the wrong dose of a diabetes medicine for the past year. Thanks to the review, he now takes the correct dose.
He said: “I’m glad nothing happened to me. I’ll be going back in a few months’ time for another review.”