Browsing by Author "Wickramasinghe, N.D.D."

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Clinical Pharmacists‟ Interventions to Improve Inhaler Use among Chronic Kidney Disease (CKD) Patients.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Wickramasinghe, N.D.D.; Lynch, C.B.; Coombes, J.; Jayamanne, S.F.; De Silva, S.T.
Inappropriate use of asthma inhalers can lead to increased hospitalizations, reduced quality of life (QOL), loss of productivity and increased health related costs. Pharmacist-led interventions have shown an improvement of inhaler technique and use. The following cases describe opportunities for clinical pharmacist-led interventions to resolve problems associated with inhaler use identified from an ongoing study in renal clinic, Teaching Hospital, Anuradhapura.
Pharmacist counselling: A new practice for improving out-patient management of diabetes in Sri Lanka
(Sri Lanka Medical Association, 2018) Mamunuwa, A.M.G.N.; Coombes, J.; Lynch, C. B.; de Silva, A.; Wickramasinghe, N.D.D.; Jayamanne, S.F.
INTRODUCTION AND OBJECTIVES: Our study assessed the effectiveness of pharmacist counselling on outpatient management of diabetes. Though this is new to Sri Lanka, many countries include this practice to achieve target treatment outcomes of patients with diabetes.METHODS: 800 participants with diabetes attending outpatient clinics of two Sri Lankan hospitals were assigned either intervention group (IG) or control group (CG). IG received pharmacist counseling for four consecutive monthly visits in addition to standard care. CG received standard care only Glycaemic control was assessed using Glycosylated haemoglobin (HbAlc) post-intervention Adherence and patient-knowledge were assessed using questionnaires at baseline and post-intervention. RESULTS: A Wilcoxon signed-rank test showed that the 4-month intervention made a statistically significant improvement in adherence in the IG. The IG had median adherence score of 5 out of 8 (IQR 6-3 3) at baseline which increased to 7 (IQR 8-6) post-intervention There was no significant change in adherence in the CG.The IG had median HbAlc of7.2% (IQR 1.5%) post-intervention whereas CG had median of7.7% (IQR 1.95%). This difference was statistically significant.The IG had a median score of 36. l 5% (IQR 48% - 24.07%) for the medication related knowledge domain which increased to 65% (IQR 76.4% - 50.4%) post-intervention (P value< 0 001). The CG did not have a significant change in the same at baseline and post-intervention (P = 0 15). CONCLUSION: Pharmacist counselling improved medication adherence, glycaemic control and patients' knowledge. Thus, it can effectively be used for improving the outpatient management of diabetes in Sri Lanka.
The role of pharmacist counselling in the control of diabetes
(Sri Lanka Medical Association, 2017) Mamunuwa, A.M.V.G.N.; Jayamanne, S.F.; Coombes, J.; de Silva, A.; Lynch, C.B.; Wickramasinghe, N.D.D.
INTRODUCTION & OBJECTIVES: Diabetes is a global health burden. Data in international literature prove the success of involving pharmacists to achieve glycaemic control. This is the first study in Sri Lanka on the impact of pharmacist counselling among outpatients with diabetes. The objective was to assess the impact of pharmacist counselling on glycaemic control of outpatients with diabetes. METHODS: A total of 400 consecutive patients with diabetes mellitus attending the outpatient diabetes clinics at Base Hospital, Dambadeniya, were randomized into either the intervention group (IG) or the control group (CG). IG received pharmacist counselling (verbal and written) for four consecutive monthly visits in addition to the standard care at the clinic, while the CG received standard care only. Glycaemic control was assessed for both groups with HbA1c measured at the end of the four monthly visits.RESULTS: Mean age of participants was 57.14±10.15 years and 67.5% were females. Non parametric tests were performed as data did not follow the normal distribution. On analysis of HbA1c data, the IG had a median of 7.2% (IQR: 8.2%-6.5%) whereas the CG had a median of 7.7% (IQR: 8.8%-6.9%). The IG patients had statistically lower HbA1c levels compared to the CG patients, according to the Mann-Whitney U test (p<0.05). HbA1c levels <8.00% indicate good/fair glycaemic control. 73.9% of the IG, but only 58% of the CG subjects had levels <8.00%. However, 9.1% of the IG and 10% of the CG had very poor glycaemic control (HbA1c level >10.00%). CONCLUSION: Pharmacist counselling in the outpatient clinics can improve the glycaemic control of patients with diabetes.
Should ‘Drug Related Problems’ remain unnoticed among patients with chronic kidney disease of uncertain aetiology?
(Sri Lanka Medical Association, 2023) Wickramasinghe, N.D.D.; Lynch, C.B.; Coombes, J.; Jayamanne, S.F.; de Silva, S.T.
INTRODUCTION: Chronic kidney disease of uncertain aetiology (CKDu) is a major public health concern in Sri Lanka. CKDu patients often consume 10-12 drugs per day, which can result in drug-related problems (DRPs). However, emerging economies such as Sri Lanka have few safeguards in place to detect and report DRPs. OBJECTIVES: The objective of this study was to introduce clinic-based pharmacy services to detect, address and report DRPs that occurred in CKDu out-patients. METHODS: A randomized controlled clinical trial was conducted in pre-dialysis CKDu stages 4 and 5 patients at outpatient renal clinics in Teaching Hospital, Anuradhapura, Sri Lanka. DRPs were identified in both groups at baseline. The control group received usual clinic care while the intervention group received medication counseling by a clinic-based pharmacist. DRPs were identified in both groups after 12 months. RESULTS: At baseline, there were 123 and 126 patients in the control and intervention groups, respectively. 133 and 147 DRPs were identified from 80 and 79 patients in the control and intervention groups, respectively. The median number of DRPs per patient was 1 (1-2) (p=0.458) for both groups. After 12 months, there were 101 and 98 patients in the control and intervention groups, respectively. 137 and 59 DRPs were identified from 57 and 33 patients in the control and intervention groups, respectively. The median number of DRPs per patient was 2 (1-3) and 1 (1-2) (p=0.029) in control and intervention groups, respectively. CONCLUSION: A “clinic-based pharmacist” counselling is a beneficial additional service for identifying and addressing DRPs occurring in patients with CKDu.
A Study to assess the improvement of management outcomes in chronic kidney disease of uncertain etiology by introducing clinical pharmacy services to selected out patient renal clinics in the north central province Sri Lanka
(University of Kelaniya, Sri Lanka, 2020) Wickramasinghe, N.D.D.
OBJECTIVES: To assess impact of “clinic-based pharmacist’ services on drug adherence and health outcomes in stage 4 or 5 pre-dialysis Chronic Kidney Disease of uncertain etiology (CKDu) patients in an out-patient renal clinic in North Central Province, Sri Lanka. METHODOLOGY: A randomized controlled clinical trial was conducted in Teaching Hospital, Anuradhapura. Demography, drug adherence (using BMQ Score), management outcomes, and Quality of Life (using KDQOL-SF™) were assessed. Intervention(I) group received four counseling sessions by a “clinic-based pharmacist” plus usual clinic care over 12 months. Control (C) group received usual care. RESULTS: Of 256 eligible patients, 127 were allocated to C and 129 to I. Demography and baseline outcome measures were similar. At 12 months, median BMQ scores improved from 5(3-5) to 3(2-4) (p<0.050), mean hemoglobin (Hb) levels improved from 11.02±1.44g/dL to 11.41±1.37g/dL (p<0.050) and QOL improved in I group. In C group, mean diastolic blood pressure and mean serum creatinine increased and eGFR was reduced, but those outcomes were unaltered in I group. CONCLUSION: “Clinic-based pharmacist” services improved drug adherence, Hb levels and QOL in stage 4 or 5 pre-dialysis CKDu patients. This service can improve disease outcomes.