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Bariatric pharmacist and conception

The role of the pharmacist and conception advice

Bariatric patients in particular often have many medications which can be difficult to administer in the early postoperative phase leading to potential issues with compliance and under treatment of medical comorbidities
Approximately 80% of patients who present for bariatric surgery are female and 66% of child-bearing age

The majority of bariatric patients are on some form of medication to treat, in most cases, obesity related conditions. When these patients undergo bariatric surgery it is imperative that they receive professional advice as they way in which the medication is absorbed by the body can dramatically change following surgery. Speaking at the 6th Annual Meeting of the British Obesity and Metabolic Surgical Society 21-23 January, in Newcastle, UK, Chloe Palmer from the Queen Alexandra Hospital, Hampshire, UK, said that bariatric pharmacists play a vital role in the multidisciplinary management of bariatric patients undergoing surgery.

Chloe Palmer

She began by stating that after surgery the ability to handle medication can be impeded due to compromised stomach capacity and impaired bioavailability of drugs absorbed in the upper gastrointestinal tract. Bariatric patients in particular often have many medications which can be difficult to administer in the early postoperative phase leading to potential issues with compliance and under treatment of medical comorbidities.

In this study, Palmer and colleagues reviewed patient records to assess the effectiveness of their centre’s practice of a pharmacist working alongside the nurse specialist in the bariatric pre-operative assessment clinic.

Since February 2014, 71 patients were seen by the pharmacist, who carried out a complete pharmaceutical history and assesses the suitability of any regular medicines post-operatively. Using appropriate resources the pharmacist reviewed patient’s regular medication and assessed the need for any changes to drug choice or formulation.

The results showed that 74.6% of patients have required an intervention for their medication. Of the 71 patients, 67.6% required a manipulation of medication formulation and 45% of patients required a change in the drug choice. A total of 193 interventions were made.

“Intensive assessment from pharmacists leads to multiple changes in medications and formulation,” she said. “This makes the early postoperative course more manageable in terms of numbers of medications and formulation and we suggest leads to more compliance with medication use and thus less drug errors.”

Co-authors of this study were Nicola Hill, Alison Sutton and Nicholas Carter (Queen Alexandra Hospital, Hampshire, UK)

Contraception

Approximately 80% of patients who present for bariatric surgery are female and 66% of child-bearing age. Current recommendations advise that patients should not conceive for at least a year after surgery and therefore contraceptive advice is an important aspect of patient care, said Yitka Graham from the University of Sunderland, Sunderland, UK, however little is known about the knowledge base of MDT members.

To establish if bariatric patients were received advice, Graham and colleagues questioned BOMSS members, via an on-line questionnaire, on their ability to provide contraceptive advice and need for further education in order to establish baseline data of current knowledge regarding existing contraceptive practices among UK bariatric surgical teams.

Questionnaires were sent to 382 BOMSS members and received 64 responses. Most responses were from surgeons (23), then dietitians (22) and nurses (12). The majority had been practicing for less than six years. Most (97%) accepted responsibility for patient education, but felt the nurse was best placed to deliver this.

Yitka Graham

Despite the recognised need to educate patients, no leaflets or posters were available in over 93% of bariatric clinics. A further 78% of respondents were ignorant of appropriate contraceptive methods for morbidly obese women, 56.5% were not confident discussing contraception, 83% wanted better communication with contraceptive providers and 87% wanted more training. The most popular methods of professional education were publication of guidelines, education at BOMSS meetings and on-line learning.

“Bariatric surgical teams do not feel confident in discussing contraception with patients and there is a recognised need for education and training of MDT members in giving contraceptive advice to morbidly obese, reproductive-aged female patients,” said Graham. “This requires improved communication between bariatric teams and contraceptive providers. The use of internet disseminated guidelines, on-line learning modules and specific BOMSS-accredited educational meetings is recognised.”

Co-authors of this study were Scott Wilkes1 Peter K Small2, Diana Mansour3 (1University of Sunderland, Sunderland, UK, 2City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK, 3Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK)

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