Mathew, T Francis (2012) Effectiveness of Knowledge Based Approach for the Improvement of Patient Adherence and Reducing the Severity of Adverse Drug Reaction in Anti Tubercular Therapy. Masters thesis, KMCH College of Pharmacy, Coimbatore.
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Abstract
The present study was performed in the department of pulmonology at Kovai Medical Center and Hospital, Coimbatore. This study was principally emphasized in absolute care of tuberculosis patients throughout their intensive phase therapy by providing a knowledge based approach to improve the drug adherence and reducing the severity of adverse drug reaction. A patient information pamphlet named as “THINGS TO BE NOTICED WHILE TAKING MEDICINES FOR TUBERCULOSIS” was already prepared which was used in the current study which includes the essential information regarding therapy, possible ADRs during the ATT and the emergency number to contact in case of any emergency due to adverse drug reactions or to take prior booking for the next review. A well experienced and skilled pharmacist counseled the patients with the help of scheduled pamphlet and enables the patients to adhere with the ATT and deal with the possible ADRs. Entirely 60 patients were included in our study. Tuberculosis was predominant in males. Our study found that TB occurred chiefly in age group of “46-60”. Majority of them had PTB. Most of the patients needed hospitalization (83%) during the initial phase of the study. A total of 58% patients had smoking habit which could be a result of increasing the risk of infection with TB mycobacteria in these individuals. Smoking can decrease the immunity or damage the functioning of cilia in the airways which may increase the risk of getting infected easily. Most of the patients were presented with cardinal signs of TB such as cough, haemoptysis and weight lose. In our study all the patients got the counselling from the well experienced clinical pharmacist with the help of a pamphlet and the knowledge was assessed by giving them a knowledge evaluation questionnaire. And 7 patients who failed to answer properly were re-counseled by the clinical pharmacist. So that they could understand the treatment properly and adhere to ATT. A total of 60 patients that is entire population came for the first review and 50 (90%) patients came for the third review which is a very good response from the patients still to achieve full adherence further possible steps should be taken. Out of 60 patients 40 were having no education or a primary education where as rest of the patients were well educated. However no significance was found between education and review pattern of the patients in our study. Living standard of the majority of the patients were found to be poor or average which could be a reason for getting infected by the TB mycobacteria as they may be undernourished, increasing the rate of active TB. Where as when comparing the review pattern by these patients it was found that the patients with high living standard have 100% adherence with ATT who came for all the three review during the intensive phase of treatment. A total number of 16 ADRs were reported by 15(25%) patients with one patient reported with two ADRs. It was found that hepatic biliary system were the major spot for the incidence of ADR. It showed that 67% of ADRs occurred within the 15 days of ATT and day by day the incidence of ADRs was decreasing. Occurrence of adverse effects or unawareness about how to deal with the ADRs may influence the patients from stopping the ATT and finally the occurrence of drug resistance. There plays the role of a pharmacist where he can implement a good patient care by providing information about the treatment and possible ADRs and what to do if any of them is suspecting. As a pharmacist, we have the liability to support the patients during the periods of ATT, while they were suffering these kinds of unwanted effects of the drug. Amplified healthcare cost. If a proper educational system is implemented like our study, most of the patients were ready to adhere with the treatment with 90% of adherence and there by increasing the therapeutic outcome. In our study totally 6(10%) patients were dropped out of intensive phase of the ATT out of which majority were living very far from the study center. So it is clear that that patient who stays near to the clinic shows more compliance with ATT. A good constitutional system of communicational approach to the patient by group effort of the pharmacist and physician with the aim of complete patient care will aid for early detection of the ADRs of any drug and can trim down the incidence and severity of the same. Since DR is the major emerging problem during ATT, implementation of well communicated system like pharmacist counselling will help to hoist the patient‟s self-assurance in the treatment and reduced incidence of DR. One recommendation of this study is to implement a new-fangled call system along with knowledge based approach by a pharmacist, which alarms the patient to come for the next review in right time for a better adherence. In this prospective observational study, it is suggested that the clinical pharmacist should exhibit their vital role during TB therapy in TB centers, pulmonology departments and DOTS centers to guarantee a better patient therapeutic outcome.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Anti Tubercular Therapy; TB mycobacteria; TB centers |
| Subjects: | PHARMACY > Pharmacy Practice |
| Depositing User: | Ravindran C |
| Date Deposited: | 16 Oct 2017 05:28 |
| Last Modified: | 16 Oct 2017 05:28 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3678 |
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