Deepa, P M (2018) Assessment of Impact of Clinical Pharmacist Counseling on Compliance and Low Density Lipoprotein Goals. Masters thesis, J.K.K. Nattraja College of Pharmacy, Komarapalayam.
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Abstract
AIM AND OBJECTIVES: Reductions in low-density lipoprotein (LDL) cholesterol decrease the risk of recurrent myocardial infarction and death in healthy individuals and patients with coronary artery disease. Lowering LDL levels also slows the progression of coronary atherosclerosis. While maintenance of therapeutic treatment is essential for patients with hyperlipidemia, many, do not adhere to the prescribed medication regimen as hyperlipidemiais a painless condition and is usually perceived byte patient. Recently, a cohort study further pointed out that the discontinuation rates observed in the primary care settings were higher than those in clinical trials, suggesting that noncompliance with lipid-lowering drugs is a major issue at the usual clinical practice setting. Pharmacists can contribute to positive outcomes of pharmacotherapy by educating and counseling patients to prepare and motivate them to follow their pharmacotherapeutic regimens and monitoring plans. Studies have shownthatlipid clinics managed by pharmacists produced improvements in these areas. It is obvious that efforts to improve compliance and long-term use of lipid-lowering therapy are necessary, especially in high-risk patients. The effective management requires long-term face-to-face counseling, which may not be feasible for large numbers of patients or for those living in outlying areas. An alternative approach to enhance compliance and improve outcomes is telephone follow-up. Therefore, we assessed the impact of personalized telephone follow-up on the rate of compliance in high-risk, hypercholesterolemic patients receiving combination drug therapy. AIM OF THE STUDY: To study the impact of personalized telephone follow-up on the rate of compliance and cholesterol level in hypercholesterolemic patients receiving drug therapy OBJECTIVES: 1. To study the demographic profile of Hyperlipidemic patients. 2. To study the nonadherencein hyperlipidemic patients. 3. To study the impact personalized telephonic follow-up on the rate of reduction in compliance and cholesterol level in hyperlipidemic patients. METHODS: Patients will be recruited from a freestanding outpatient clinic, associated with the Tertiary care hospital, Erode. A patient was eligible for the study if he/she was between the ages of 30 and85 years and had CHD, taking at least aspirin or other acceptable therapies (clopidogrel, ticlopidine, warfarin) and who received refill prescriptions for lipid-altering medications (HMG-CoAreductase inhibitors, niacin, fibrates, or bile acid sequestrants) during the6-month period. After institutional review board approval, patients have baseline fasting LDL above 130 mg/dl will be recruited. They had to be able to understand and speak Tamil, and to have a telephone/mobile phone in their home. Written informed consent was obtained from each participant. Each participant will be extensively counselled on the appropriate use of the drugs at the time the prescriptions written. Primary end points of the study were the percentage of patients at goal LDL below 100 mg/dl + 5% (excluding patients with triglycerides > 400 mg/dl), (A goal LDL below 105 mg/dl was chosen since the laboratory assay has a margin of error of + 5%, and we wished to afford some latitude for providers’ clinical judgment. A randomization schedule was developed using a computer-generated list of random numbers. Patients were randomized to a treatment or control group upon meeting the inclusion criteria and after agreeing to participate in the study at their first follow-upvisit. Patients enrolled in the treatment group were followed by the pharmacist directed lipid management program, as described below. Control group patients were informed of their cholesterol levels and told they should contact their health care provider for further follow-up. Lipid profiles were measured at baseline, at 2 months after starting study. A pharmacist telephone to intervention group patients at their home every week for 2 months. During telephonic interaction, an emphasis was placed on the importance of therapy in reducing the risk of recurrent cardiac events. Patients will be questioned about potential side effects, overall well-being, and specific reasons for noncompliance when applicable. The counselling involve providing information about the indication, dose, and frequency of lipid-lowering drugs. Dietary advice mentioned briefly. The data collection tool is a questionnaire, designed-based on an extensive literature review of similar studies. The questionnaire included information regarding patient demographics and clinical characteristics such as: sex, age, education, income, medical history, and co-morbidities. Adherence assessmentcan be obtained through the 8-item self-report Morisky Medication Adherence Scale (MMAS). Each item measuresa specific medication-taking behavior. CONCLUSION: There is significant potential for clinical pharmacists to contribute to improvementin the efficiency and effectiveness of pharmacotherapy in patients with dyslipidemia. As demonstrated in this study, interdisciplinary medical teams that include clinical pharmacists in lipid managementrealize greater reductions in LDL for patients who have been assessed with multiple risk factors compared to patients without clinical pharmacist management of dyslipidemia. Similarly, pharmacist-delivered intervention improved patient adherence. Active participation by clinical pharmacists in lipid managementforall patients with elevated LDLresults in improved intermediate outcomesin the achievement of lipid goals. These intermediate outcomes mayresult ultimately in reduced long-term cardiovascular events and an improved quality of life for patients with dyslipidemia as well as reduced long-term costs associated with sequelae of dyslipidemia. Increased treatment efficiency in the management of dyslipidemia by clinical pharmacists may permit providers to address and manage other aspects of their patients’ health.
| Item Type: | Thesis (Masters) |
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| Additional Information: | REG.No.261640202 |
| Uncontrolled Keywords: | Impact of Clinical Pharmacist Counseling ; Compliance ; Low Density Lipoprotein Goals. |
| Subjects: | PHARMACY > Pharmacy Practice |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Jul 2019 15:09 |
| Last Modified: | 03 Jul 2019 02:49 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/10690 |
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