Designing a Pharmacist-Led Medication Review Service for Patients with Multimorbidity in Rural Health Facilities in Taraba State

Patients with multiple chronic conditions in rural Taraba State, North East Nigeria, face elevated risks from polypharmacy and drug-related problems, yet structured pharmacist medication review services are virtually absent from rural health facilities. This study designed a pharmacist-led structured medication review service for patients with multimorbidity attending rural health facilities in Taraba State. A service design methodology incorporating patient profiling, pharmacist capacity assessment, service model benchmarking, and stakeholder consultation was adopted. A disease burden mapping exercise confirmed that hypertension-diabetes-malaria multimorbidity was the dominant pattern affecting 38.7 percent of chronic disease patients at rural facilities across Jalingo, Wukari, and Bali LGAs. Assessment of pharmacist availability showed a critically limited workforce, with one pharmacist responsible for multiple facilities across most LGAs. A task-sharing medication review model was designed, incorporating trained pharmacy technicians conducting structured medication reviews under pharmacist supervision through a scheduled teleconsultation model. The service encompasses medication appropriateness assessment, adherence evaluation, drug interaction and adverse effect screening, medication simplification, and patient self-management education. A structured medication review documentation tool and training materials for pharmacy technicians and pharmacists are provided. Expert review by eight clinical pharmacy and rural health specialists validated the model's feasibility under Taraba State health system conditions. The study recommends piloting the service in three rural LGAs with formal pharmacoeconomic evaluation at 18 months.

Keywords: medication review, multimorbidity, rural pharmacy, Taraba State, task-sharing