Siriraj Hospital Day 2

Today was our second day at Siriraj hospital. The majority of the day consisted of observing and working with a few of the ambulatory care clinics that the hospital has. Specifically we were able to work with the heart failure, respiratory, warfarin and organ transplant clinics. If someone asked me which one was the most memorable and interesting, I would have to say it was the warfarin clinic. Although the response may be biased by my interest in anticoagulation, it stood out to me because of the techniques that were being used in a country that struggles with health literacy and compliance. The patient we saw at the clinic had low adherence and low knowledge about their disease state. The patient was educated by the pharmacist using a book of pictures as an aid.The education of the patient was comprehensive and included information about the disease state, the drug, side effects, and the importance of a consistent diet. Although I could not understand the conversation between the patient and pharmacist, I sensed through the patient's body language that she was learning. The patient was originally instructed to take a rather complex regimen of warfarin. To address the issue of compliance, we changed the regimen of warfarin to be much more simple. In addition, the pharmacist actually filled up a pill container for a week to reflect her new regimen. To also help the patient to remember the regimen, the patient was given a calendar. This calendar (pictured below) shows the patient what dose to take and when. It uses colored stamps to signify which strength of the warfarin to take and also represents how much of the tablet to take. Both of these techniques to improve adherence are simple and taught in any pharmacy school, but I have never personally seen them implemented to the extent that they were implemented with that one patient today.