Patient Preference and Adherence (Dec 2019)
A Randomized Controlled Trial to Assess the Impact of Clinical Pharmacy Interventions on Treatment Outcomes, Health Related Quality of Life and Medication Adherence Among Hepatitis C Patients
Abstract
Salamat Ali,1,2 Mashhood Ali,3 Vibhu Paudyal,4 Faisal Rasheed,5 Shahan Ullah,1 Sayeed Haque,6 Tofeeq Ur-Rehman1 1Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan; 2Services Institute of Medical Sciences, Lahore, Pakistan; 3Department of Gastroenterology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan; 4School of Pharmacy, University of Birmingham, Birmingham, UK; 5Pakistan Institute of Nuclear Sciences and Technology, Islamabad, Pakistan; 6Institute of Applied Health Research Medical Statistics, University of Birmingham, Birmingham, UKCorrespondence: Tofeeq Ur-RehmanDepartment of Pharmacy, Quaid-I-Azam University, Islamabad, PakistanTel +92 51 9064 4135Email [email protected]: The role of specialized pharmacy services remains unexplored in clinical practice for hepatitis C patients in Pakistan. This study aimed to evaluate the impact of clinical pharmacy interventions on treatment outcomes, health-related quality of life (HRQoL), and medication adherence among hepatitis C patients.Methods: A randomized control trial was conducted at two tertiary-care teaching hospitals in Pakistan. Hepatitis C patients who attended the outpatient clinics between October 2015 and September 2018 were randomized to two groups [usual care (UC) and pharmaceutical care (PC)] in a 1:1 ratio, applying simple envelope method. The PC group received pharmaceutical care led by a clinical pharmacist. The care that patients received included education and counseling on medication compliance, labeling of medication packs, and monitoring of adverse drug events, led by a qualified clinical pharmacist during the 15- to 20-minute monthly sessions, while the UC group received standard care at hospital, which did not involve clinical pharmacist input. Outcome measures, such as sustained virological response, HRQoL, and adherence rate (pharmacy data) were assessed at enrolment and distinct time intervals: 4 weeks, 8 weeks, and end of treatment.Results: A total of 931 patients were included in the study (UC 466 and PC 465), with mean age 42.35±1.9 years. Sustained virological response at 12 weeks was achieved in 86.0% patients in the PC group, significantly (p<0.001) higher than the UC (69.3%) group. Fewer patients (9.9%) in the PC group reported mobility problems, significantly fewer (p<0.001) than the UC group (11.8%). Self-care, usual activity, pain, and depression were relieved significantly in the PC group compared to the UC group. The EuroQol visual analogue scale (baseline 56.1 of UC group versus 55.2 for PC group) was raised to 71.8 and 71.9 in the UC and PC groups, respectively. Medication adherence was significantly improved (p<0.001) in the PC group (88.6%) when compared to the UC group (77.9%, 95% CI 88.9%–91.9%).Conclusion: Pharmacist-led clinical pharmacy interventions as part of multidisciplinary care had a significant impact on improving cure rates, HRQoL, and medication adherence for hepatitis C patients. This study suggests that clinical pharmacists should be incorporated into the multidisciplinary health-care team for care of hepatitis C patients.Keywords: hepatitis C, clinical pharmacy, medication adherence, clinical outcomes, quality of life
