Abstract
Introduction: The work of the Family Medicine Clinic (Primary care cluster) is limited, that is, the pharmacist is not enough. Pharmacies as a co-service unit should therefore complement a complete pharmaceutical system. Method: Participatory action research in the area of Khon Kaen, Phetchabun Phitsanulok and Songkhla under the project to reduce hospital congestion by the drug store mechanism. The study period consisted of 3 research phases in Phase 1 to develop a model for the pharmacy that is a unit in conjunction with a family medicine clinic and establishing guidelines. In phase 2, putting them into practice in the area. And the research in phase 3 is to evaluate the outcome of drug use problem management. Satisfaction and opinions of pharmacists, patient and health care provider in the family medicine clinic and economic results. The objective is to develop a service model of a pharmacy that is a joint unit with a family medicine clinic. Evaluating the management of drug problems of the people who come to the pharmacy. Evaluate the satisfaction of patients and healthcare workers with the developed models and assess the economic results of the developed models. Results: The service model of quality pharmacies and GPP pharmacies as a joint service was developed. Additional pharmacy services which developed in this study are Medication therapy management (MTM) as well as waste drug management and health promotion for patients who come to receive services in the project to reduce hospital congestion by the drug store mechanism. The results of the development have resulted in the management of drug use problems. Behavioral problems, and residual medicine, found a total of 14,211.22 baht, most of which cause 55.03% of patients who did not comply in drug use, followed by 38.48% of over prescription. Most common drug related problem is noncompliance and the most common health behavior problem is diet problem. For the results of assessing the satisfaction of the clients in various areas, a full score of 5 found that the clients were satisfied at the highest level in all aspects. Both the service procedures, which consisted of the appropriateness of the service procedures by community pharmacists (4.77 ± 0.46) and the appropriateness of the duration of service from community pharmacists (4.77 ± 0.47). Pharmacists, which consisted of service etiquette of pharmacists (4.88 ± 0.33) and pharmacists, can help resolve drug use problems of patients (4.81 ± 0.44). Knowledge of disease and self-received drugs (4.72 ± 0.51) applied knowledge gained from community pharmacists to apply for self-care (4.75 ± 0.48) and reduce the time to wait for service compare with hospital (4.86±0.37) and overall satisfaction (4.87±0.36). The results of the satisfaction assessment of pharmacists were the highest (4.27 ± 0.69). Except for the appropriateness of compensation which was satisfied at a high level (3.84 ± 0.86). It was found that the total cost per time of service in the model 1 was 104.24 baht per time of service. It can be seen that the cost of drugstores in Model 1 is greater than the remuneration paid by the NHSO to the pharmacy, which is 70 baht per time of service. In addition, when the cost per item of drug is 31.03 baht per one item of medicine dispensed by the pharmacist and giving advice on drug use. For model 2, it was found that the cost per time of service was 176.73 baht per time, it can be seen that the cost of Model 2 is 106.73 baht higher than the remuneration paid by the NHSO to the pharmacy. Conclusion: The drugstore in the project to reduce hospital congestion by the drug store mechanism should be provide Medication therapy management (MTM) and health promotion services to patients, in addition to prescribing and giving medication advice because people are benefiting and satisfied. The National Health Security Office should increase the remuneration for pharmacists in Model 1 to at least 100 baht per visit and Model 2 to at least 170 baht per visit and to develop the potential of all pharmacies in the project to be able to provide services to manage drug use problems and health promotion to the patients.
