Suhaj Abdulsalim1, Mazhuvancherry Kesavan Unnikrishnan2, Mohan K Manu3, Alian A Alrasheedy4, Brian Godman5, Donald E Morisky6. 1. Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, 576104, Manipal, India; Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Electronic address: a.suhaj@gmail.com. 2. Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, 576104, Manipal, India; Department of Pharmacology, National College of Pharmacy, Manasseri, Kozhikode, Kerala, India. Electronic address: unnikrishnan.mk@nationalcollegeofpharmacy.org. 3. Department of Pulmonary Medicine, Kasturba Medical College Hospital, Manipal University, 576104, Manipal, India. Electronic address: manumohan73@gmail.com. 4. Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Electronic address: Alian-A@hotmail.com. 5. Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden; Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK. Electronic address: Brian.Godman@ki.se. 6. Distinguished Chair Professor at Kaohsiung University, Taiwan; Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, USA. Electronic address: dmorisky@ucla.edu.
Abstract
BACKGROUND:COPD is characterised by a progressive airflow limitation in the lungs. However, adherence to therapy improves management of symptoms and delays disease progression. Therefore, patients' knowledge and awareness about the disease are important. Hence, pharmacist-led educational interventions could achieve this and improve medication adherence. OBJECTIVE: This study evaluated the effectiveness of a clinical pharmacist-led intervention on medication adherence in COPD patients in a teaching hospital. METHODS: In an open-labelled randomized controlled study at Kasturba Medical College Hospital, Manipal, India, patients were randomly assigned to two groups (Intervention group [IG] and Control group [CG]), and were matched for socio-demographics and clinical characteristics. Medication adherence was assessed by the Morisky, Green and Levine Medication Adherence Questionnaire (MAQ). In IG, pharmacist intervention placed emphasis on (1) compliance, (2) smoking cessation, (3) exercise, (4) inhaler use and (5) need for timely follow up. The MAQ assessment was repeated at 6, 12, 18 and 24 months. Data were analysed statistically by SPSS version 20.0. RESULTS: Out of 328 patients screened during March 2012 to June 2013, 260 were recruited. Of these, 206 completed the follow-up (98 in CG and 104 in IG). Medication adherence improved significantly after pharmacist intervention in IG at all follow-up time points (P < 0.001). It increased from 49% at the baseline to 80% after 24 months (P < 0.001). Carelessness about taking medicines was one of the main reasons for non-adherence in COPD patients, but was effectively reduced by the intervention. CONCLUSIONS: This is the first randomized controlled trial in India that demonstrates the pivotal role of pharmacist-led educational intervention in improving medication adherence in COPD. Involving non-physician health professionals could be the best strategy, for resource-poor nations like India, because the current physician-centric healthcare has no emphasis on patient education and counselling.
RCT Entities:
BACKGROUND:COPD is characterised by a progressive airflow limitation in the lungs. However, adherence to therapy improves management of symptoms and delays disease progression. Therefore, patients' knowledge and awareness about the disease are important. Hence, pharmacist-led educational interventions could achieve this and improve medication adherence. OBJECTIVE: This study evaluated the effectiveness of a clinical pharmacist-led intervention on medication adherence in COPDpatients in a teaching hospital. METHODS: In an open-labelled randomized controlled study at Kasturba Medical College Hospital, Manipal, India, patients were randomly assigned to two groups (Intervention group [IG] and Control group [CG]), and were matched for socio-demographics and clinical characteristics. Medication adherence was assessed by the Morisky, Green and Levine Medication Adherence Questionnaire (MAQ). In IG, pharmacist intervention placed emphasis on (1) compliance, (2) smoking cessation, (3) exercise, (4) inhaler use and (5) need for timely follow up. The MAQ assessment was repeated at 6, 12, 18 and 24 months. Data were analysed statistically by SPSS version 20.0. RESULTS: Out of 328 patients screened during March 2012 to June 2013, 260 were recruited. Of these, 206 completed the follow-up (98 in CG and 104 in IG). Medication adherence improved significantly after pharmacist intervention in IG at all follow-up time points (P < 0.001). It increased from 49% at the baseline to 80% after 24 months (P < 0.001). Carelessness about taking medicines was one of the main reasons for non-adherence in COPDpatients, but was effectively reduced by the intervention. CONCLUSIONS: This is the first randomized controlled trial in India that demonstrates the pivotal role of pharmacist-led educational intervention in improving medication adherence in COPD. Involving non-physician health professionals could be the best strategy, for resource-poor nations like India, because the current physician-centric healthcare has no emphasis on patient education and counselling.
Authors: Jade Schrijver; Anke Lenferink; Marjolein Brusse-Keizer; Marlies Zwerink; Paul Dlpm van der Valk; Job van der Palen; Tanja W Effing Journal: Cochrane Database Syst Rev Date: 2022-01-10