Impact of medication counselling by pharmacists in patients with diabetes,attending rural and urban outpatient clinics in Sri Lanka.

Abstract

Introduction & Objective: The intervention of pharmacists in the management of diabetes is well studied throughout the world. Many countries include this practice to achieve target treatment outcomes of patients with diabetes. Our study assessed the effectiveness of pharmacist counselling on outpatient management of diabetes. Despite the high and rising prevalence of diabetes in Sri Lanka, this is the first study to evaluate a clinic-based pharmacy counseling service in the Sri Lankan diabetes population. Methods: 800 participants with diabetes attending outpatient clinics of two Sri Lankan hospitals were assigned to 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. The effectiveness of the intervention was assessed in terms of glycaemic control, adherence to medicines, patients* knowledge regarding medicines and disease. Quality of life (QoL) and the detection and resolving of drug related problems. Data was analyzed using Statistical Package fbr the Social Science (SPSS) software. Nonparametric tests were used as the data did not follow normal distribution. Results: Age ranged from 23 to 87 years. 67. 25% were female. At the end of the study, 359 and 360 participants remained in the control and intervention groups respectively. The IG had a median HbAlc of 7.2% (IQR 1.5%) post-inte^ention compared with the CG median of 7.7% (IQR 1.95%) (p<0.05%). The IG had a median adherence score of 5 out of 8 (IQR 6-3.3) at baseline which increased to 7 (IQR 8-6) post-intervention (p<0.05). CG median score was 5.3 (IQR 7-4) and 5 (IQR 7-4.2) at baseline and post-intervention respectively. The IG had a median score of 53% (IQR 64% - 34%) for the medication related knowledge domain, which increased to 73.3% (IQR 81% - 65%) post-inte^ention (p<0.001) The CG score was 50% (IQR 63% - 34.25%) at baseline and 50% (IQR 63% ・ 33.47%) post¬intervention (P=0.84I). The IG had a median percentage score of 50.48% (IQR 59% -41%) for the QoL questionnaire, which increased to 51.13% (IQR 61% - 42.5%) post-inten^ention (P=0.001). The CG score was 49.19% (IQR 59% - 39%) at baseline and 49.06% (IQR 59% - 39%) post-intervention (P =0.659). A total of 252 DRPs were detected. Acceptance of pharmacy interventions was high with 75.64% of problems being totally or partially solved. Conclusion: Pharmacist counselling improved medication adherence, glycaemic control, patients' knowledge regarding medication management and quality of life of the patients. It is helpful in addressing and resolving the drug related problems. Thus, pharmacist counseling can effectively be used to improve the outpatient management of diabetes in Sri Lanka.