Author: Urvashi Gahlot, Harshil Jagan
(Pharm- d students), Geetanjali Institute of Pharmacy,
Geetanjali University, Udaipur (Raj.) 313002
Treating patients with multimorbidity has always been a challenge for the doctors. Earlier it was considered that it is related to aging or genetic but most of the studies to date revealed that it is also because of change in pattern of living, job profile, surrounding environment along with various socioeconomic factors and chronic conditions lasting for longer period of exposure time of patient.
During these days, treatment of Covid patients in different age groups, complications observed without prehistoric existence in clinical history as challenge i.e., development of black fungus, lung infections with breathing complications, muscles weakness/dysfunctions, cardiac problems, depression etc. as post covid syndrome. This requires a drug expert as an overseer to manage the juggle of all the evidence-based prescriptions to prevent delicacy and complications.
Qualified Clinical Pharmacist plays an important role in suggesting the right drug with the right quantity of doses as per gender, age and complications. He understands the drug formulations and their interactions in-depth. He has professional approach for drug management with condition-based monitoring reviewing evidences/test reports of patient.
Challenge and limitations:
Mr. Rahul was suggested by his doctor a high protein diet for COPD (chronic obstructive pulmonary disease), while another want him to limit protein as he is also a CKD (chronic kidney disease) patient. Now, what will he do? One doctor may want you to exercise a certain way, but another one may say you need to avoid exercise. Such complications are very common in world nowadays. Treating right to patients like this is immensely challenging.
The treatment offered to patients generally based on physical symptom, evidence and test reports of individual. Classical clinical practice guidelines largely configured around treatment of single diseases thus restricting the extrapolation of these protocols to manage sufferer from multimorbid. Medications that might be advisable to cure one medical condition may have unacceptable effects and add greater risk of dangerous drug interactions and make the other condition dreadful. Therefore, patients suffering with coexistence of two or more chronic conditions create need specific review and simplify drug management for optimum intake schedule with minimum side effects
Routine or periodic heath check-up is still uncommon or less adopted practice in developing counties. People visit or consult health practitioners only in case of two facing difficulties in their routine life or accidental conditions. Mostly unaware of preliminary symptom and their hidden complications. After examination of Health experts and medical test, he may refer to further specialist doctor with a specific area of speciality for consultancy and treatments. Each Specialist has own method of drug management, if the person is suffering from multiple disease, he may find himself in a trap of various antibiotic, vitamins supplements, immunity booster along with medicines of each individual specialist. These challenges are further limited due to
Visiting a number of specialists, receiving contrasting and conflicting advice regarding treatment it becomes bemusing, as well as it might sometimes be contradictory and dissatisfactory not only to the patient but to the other doctor as well.
According to research, the prevalence of multimorbidity i.e., the coexistence of two or more chronic conditions in a person at same time, in adults is 7.2%. This data is just for the chronic conditions, there are lots and lots of other acute conditions which have not been calculated or taken into consideration on this scale. This is huge. There is still no count of conditions in the paediatrics and geriatrics. Moreover, the patients and their guardians do not even know how to handle the situation and whom to consult as they themselves are confused most of the times about the lately occurring condition that is it a complication of the older disease or is it a side effect of any drug or some interaction.
Mostly patients blindly believe in doctors and are little aware about interactions of prescribed drugs individually. There are evidences that society has faced these situations as and when, compromising lives with their families when patient just waits for another doctor to give appointments and by then the first doctor leaves by completing his/her part of the treatment.
Need to change the approach:
In this outrageous world, healthcare is and must be the most concerning area of interest for all nations whether developed or developing.
There is the utmost need for implementation of a more standardized plan of treatment for patient with multimorbidity, as well as more flexible guidelines for treatment and the drugs prescribed under this new model. It would enable general health practitioners to strike a balance between the treatment guidelines for specific conditions and the needs of a patient as a whole.
This brings an urge to take the benefits of the complete knowledge of all the categories of drugs and diseases by the clinical pharmacists, who are specifically educated and trained for patient-specific medication taking into consideration all the details about the patient’s demographics, disease conditions, lab values, reports, medications and their side effects etc.
Clinical pharmacists are professional Pharm-D postgraduates with thorough and wide knowledge about various disease conditions and medications in detail providing evidence-based information and advice about the safe and effective use of medications along with recognising and monitoring.
Monitoring patient progress with medication and making relevant recommendations is the foremost part of their jobs. They can be very efficient in playing a key role in the interdisciplinary and inter professional bonding between all the healthcare professionals and doctors to overall benefit the patient care. It is experienced that “Any condition which is left untreated and can be treated or managed with medication therapy under qualified pharmacist”.
Infrastructure should be developed for the patients and their guardians to be provided with ease to contact and get in touch with the clinical pharmacists for each patient with any respective complaints or diagnoses so as to get assisted and helped by the clinical pharmacist for better comfort and better overall healthcare and raising the standards of hospital even higher
With the help of this article, for a more standardized plan of treatment for multimorbid patient or with complicity we want to attract attention towards significance of medication management with Pharm-D post graduates along with need of review gulidenes, adopting quality measurers, integrate care / treatment facilities. We suggest to applicate to get benefit from the inter-professional care in collaboration with the prescribing physicians, surgeons and clinical pharmacists for handling patient’s drug management. This might be a good solution to avoid uncertainty and inconvenience to the patients and their guardians along with the prescribing doctors with less burden on them and in lowering the chances of error while treating the patient.
Our aim is “Patient’s satisfaction, with holistic treatment, along with emphasis on the need for an integrative approach in the treatment.”
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