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|Title: ||A psychometric assessment of the impact of pharmaceutical care intervention on health-related quality of life in patients with Asthma|
|Authors: ||Anum, Philip William Okwei Mensah|
|Issue Date: ||17-Nov-2015|
For chronic health conditions, the traditional measures of disease impact such as prevalence,
mortality and hospitalization rates may be inadequate in understanding the extent of the
impact of the disease on the individual. Measuring Health-related Quality of Life (HRQoL)
has a role in describing health outcomes, guiding and assessing clinical management,
predicting health outcomes, formulating clinical policy and allocating health resources.
Pharmaceutical care delivery stands a good chance of positively impacting the HRQoL of
patients‘ significantly. This must however be accompanied by appropriate prescribing and the
care delivery must be oriented around the chronic model of care.
This study assessed the content and outcomes of counselling and education delivered by
pharmaceutical service providers to patients, reviewed prescribing patterns of asthma
medications and evaluated the impact of pharmaceutical care provision on HRQoL of patients
A 26-item interviewer-administered questionnaire was used to collect patient pharmacy-exit
data on 388 prescription encounters. Patient data were separated into chronic and acute health
conditions groups and the content and outcomes of their counseling and education at the
pharmacy were assessed in phase I of this study.
In Phase II, 409 prescriptions were retrospectively reviewed against the recommendations of
the national standard treatment guidelines from 4 health care facilities around the country.
Prescriptions on previous visits were selected with a developed tool just before participants
were seen by their physicians and reviewed for conformity with the recommendations of
national treatment guidelines.
In phase III, a prospective pre/post- intervention study of a cohort of 77 adult out-patients
visiting specialist asthma clinics were assessed for HRQoL and peak expiratory flow rates
one month after a pharmaceutical care intervention. The Pharmaceutical care intervention
included education on the health condition, pharmacotherapy and self-management including
correction of inhaler-use technique, where necessary and self-referral.
Participants with chronic health conditions were not provided with the same counseling and
education as their counterparts with acute health conditions. Less than 20% of participants
from the two disease condition groups received precautionary information. Close to 15% of
the participants in the chronic health group were informed about what to do in case they felt
bad or reacted to any of their medications as against 10% of participants in the acute health
group. Prescribing patterns for asthma medications indicated widespread discrepancies. Many
patients were on step III medications, an indication that most of the asthma patients had
moderate persistent condition. About 46% of participants on inhaled Salmeterol/Fluticasone
combination therapy were on dosage regimens not recommended in the standard treatment
The Pharmaceutical care intervention led to a significant improvement in asthma specific
quality of life and peak flow rates. The mean paired difference of the HRQoL for the patients
with asthma post- pharmaceutical care intervention was 0.697+0.89. A t-test analysis of the
means at 95% CI, yielded a t= 6.85 (p<0.05). The mean paired difference for peak expiratory
flow rate post intervention was 17.533+63.705 and a t=2.384 (p=0.02 at 95% CI).
The contents and outcomes from patient education and counseling at the pharmacies did not
reflect any discrimination between acute and chronic health conditions. Prescriptions for
pharmacologic therapy of asthma contained widespread inconsistent patterns as compared to
those in the standard treatment guidelines. At one month after pharmaceutical care
intervention, patients with asthma showed significant improvements with regard to asthma-specific quality of life, peak flow and knowledge.|
|Description: ||A Thesis submitted to the Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Clinical Pharmacy Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, 2015|
|Appears in Collections:||College of Health Sciences|
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