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• W2095394961 abstract "To the Editor: The population of older adults is growing in Hong Kong. According to the Hong Kong Census and Statistics Department, in 2010, the proportion of people aged 65 and older is expected to be 28% in 2036.1 Heart disease and cerebrovascular disease are, respectively, the second and fourth leading causes of death in Hong Kong.2 The Asia Pacific Cohort Study found that a 10-mmHg reduction in systolic blood pressure (SBP) was associated with a 30% reduction in deaths from cardiovascular disease and a 41% reduction in stroke.3 Poor control of hypertension and diabetes mellitus were the major reasons for referrals from general outpatient clinics (GOPC) to the emergency department in Hong Kong.4 Individuals with poor control of chronic diseases generally require more-personalized interventions to monitor adherence to treatment and lifestyle modifications.5 Hong Kong has a largely government-based subsidized healthcare system, with more than 90% of secondary and tertiary care provided in physician consultations in the public sector; a general outpatient clinic visit lasts an average of 3 to 5 minutes.6 It is difficult to provide adequate counseling and medication review during such a short visit, so the current study aimed to investigate the effect of a pharmacy outreach service (POS) in Hong Kong on hypertension and diabetic control in community-dwelling elderly adults and the sustainability of such a service. A 5-year, multicenter, prospective service was provided from 2007 to 2012 at seven senior centers in Hong Kong. Subjects aged 60 and older with uncontrolled hypertension or diabetes mellitus were recruited. Subjects were visited every 1 to 3 months and provided with medication reviews and counseling, blood pressure (BP) and glucose monitoring, hypertension and diabetes mellitus education, and adherence reinforcement from a pharmacist and trained pharmacy students. The primary outcome was change in BP between baseline and the last visit. Secondary outcomes were changes in random capillary blood glucose (RCBG) levels, body mass index (BMI), disease knowledge scores, adherence scores, and observed drug-related problems (DRPs). Three hundred sixty-five subjects (mean age 77.1 ± 7.2; 69.3% female) were followed for 5 years. Statistically significant decreases were observed in SBP (from 155.9 ± 198.8 to 146.5 ± 20.5 mmHg; P < .001) and diastolic BP (DBP; from 74.6 ± 11.3 to 70.1 ±10.2 mmHg; P < .001). Hypertension (11.7 ± 18.3%, P < .001) and diabetes mellitus (12.4 ± 13.9%, P < .001) knowledge scores increased significantly. Adherence improved significantly in the last 2 years (P < .05). Five hundred ninety-nine DRPs were identified. Changes in BMI and RCBG levels were insignificant. Subjects who participated in a POS two or more times had a significant decrease in SBP (−12.9 ± 22.2, P < .001) and DBP (−6.9 ± 11.7, P < .001) (Table 1). In Hong Kong, it was estimated that 51.8% of men and 54.5% of women aged 65 to 74 had uncontrolled hypertension, based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines.7 The current study demonstrated similar positive BP control in community-dwelling elderly adults.8 For subjects who participated in a POS two or more times, interventions were stopped after the first time they participated, and a subsequent rebound of SBP was found. A greater rebound in BP was detected in subjects who did not have continous monitoring of BP by POS, although a significant decrease in BP was observed when they re-entered the program. Thus, a sustained and ongoing POS is needed to detect subjects with uncontrolled BP and to achieve stable disease management. Elderly adults are susceptible to DRPs and the most common contributing factor is polypharmacy. Studies have shown that multiple drug use can increase the risk of DRPs in elderly adults.9, 10 The most common DRP identified was nonadherence. Dosage adjustment was the most frequent form of nonadherence. Splitting pills was commonly observed, with some people splitting pills using their hands or a knife, which leads to uneven splitting. It was found in some cases that most of the pills had been crushed into dust in the medication bags. Elderly adults often have memory problems and can be forgetful, which leads to missed doses and adjustment of the dosage, and the complexity of the regimen can make it even harder to follow and hence increase the risk of nonadherence. Thus, POS improved adherence through education, ADR management, and distribution of adherence aids such as medication boxes, charts, and calendars. Chronic disease management is inadequate with the growing population of community-dwelling elderly adults in Hong Kong. POS can help improve BP control, knowledge about hypertension and diabetes mellitus, medication adherence, and DRPs in community-dwelling elderly adults. Sustainable BP control was observed in subjects who participated in the POS at least twice. Therefore, POS should be considered for chronic disease management in elderly adults living in the community. Conflict of Interest: This study was supported by the School of Pharmacy, The Chinese University of Hong Kong. All authors declared that there was no conflict of interest with this study or the preparation of the manuscript. Author Contributions: Vivian W. Y. Lee, the principle investigator, oversaw the study concept and design, acquisition of subjects, data analysis, interpretation of data, and preparation of manuscript. Eric H. Y. Lee was involved in data analysis, interpretation of data, and preparation of manuscript. All other authors were involved in data analysis and interpretation of data. Sponsor's Role: None." @default.
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• W2095394961 date "2013-12-01" @default.
• W2095394961 modified "2023-09-26" @default.
• W2095394961 title "Effect and Sustainability of Pharmacy Outreach Services in Elderly Adults: A 5‐Year Experience in H ong K ong" @default.
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