Structured pharmacist-led intervention programme to improve medication adherence in COPD patients: A randomized controlled study |
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Authors: | Suhaj Abdulsalim Mazhuvancherry Kesavan Unnikrishnan Mohan K Manu Alian A Alrasheedy Brian Godman Donald E Morisky |
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Institution: | 1. Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, 576104, Manipal, India;2. Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia;3. Department of Pharmacology, National College of Pharmacy, Manasseri, Kozhikode, Kerala, India;4. Department of Pulmonary Medicine, Kasturba Medical College Hospital, Manipal University, 576104, Manipal, India;5. Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden;6. Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK;g. Distinguished Chair Professor at Kaohsiung University, Taiwan;h. Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, USA |
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Abstract: | BackgroundCOPD 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.ObjectiveThis study evaluated the effectiveness of a clinical pharmacist-led intervention on medication adherence in COPD patients in a teaching hospital.MethodsIn 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.ResultsOut 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.ConclusionsThis 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. |
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Keywords: | Pharmacist intervention Medication adherence COPD patients Randomized controlled study MAQ |
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