PHARMACEUTICAL CARE IN LIVER TRANSPLANT OUTPATIENT CLINIC AT
SIRIRAJ HOSPITAL
Pornpen Leuvittawat1,*, Suvatna Chulavatnatol1,#, Thida Ningsananda2 and Yongyut
Sirivatanauksorn3
1
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400
Thailand
2
The Association of Hospital Pharmacy (Thailand), Bangkok 10110 Thailand
3
Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
10700 Thailand
*e-mail: pornpen.leu@mahidol.ac.th, #e-mail: suvatna.chu@mahidol.ac.th
Abstract
Liver transplantation (LT) is the most effective treatment for patients with end stage
liver disease (ESLD). Liver transplant patients are usually having risk for drug therapy
problems (DTPs) because of poly-pharmacy, involving immunosuppressants, anti-infective
agents and other medications for their underlying diseases. The present study, therefore,
aimed to identify and resolve DTPs after LT through clinical pharmacy service. A total of 75
patients in Liver Transplant Outpatient Clinic at Siriraj Hospital who were ≥ 18 years of age
and were able to communicate with pharmacist were recruited. Research pharmacist assessed
for DTPs and provided interventions in the 1st visit and monitored for intervention outcomes
and provided counseling to patients in the 2nd visit. Fifty-six DTPs were identified in 28
patients in the 1st visit (2.00±1.19 DTPs/patient), while 26 DTPs were identified in 19
patients in the 2nd visit (1.37±0.83 DTPs/patient. “Noncompliance” was the major DTPs
found in the study, 62.50% and 65.38% at the 1st visit and the 2nd visit, respectively. The
second rank of DTPs were “unnecessary drug therapy” (10.71%) and “dosage too high”
(10.71%) in the 1st visit and “need additional drug therapy” (15.38%) in the 2nd visit. A total
of 82 pharmacist interventions were provided. Most of them could decrease “unnecessary
drug therapy”, “dosage too low” and “dosage too high” problems. For “noncompliance”, it
might need more intensive pharmaceutical care process to decrease such problem. The
physicians’ acceptance rates for the interventions were 65%-80% whereas 100% acceptance
rate was achieved from patients. In conclusion, pharmaceutical care had been shown to have
beneficial effects for liver transplant patients particularly in the reduction of some DTPs.
However, “noncompliance” was still a major DTP which might need intensive
pharmaceutical care process to overcome.
Acknowledgements:
The authors would like to express our appreciation to Faculty of Medicine Siriraj Hospital,
Mahidol University for partially support for the research grant. Contribution from liver
transplantation teams including physicians, nurses, pharmacists, and all patients are also
appreciated.
Keywords: Pharmaceutical care, Pharmacy service, Liver transplant patients