Structured pharmacist-led intervention programme to improve medication adherence in COPD patients: A randomized controlled study

Suhaj Abdulsalim; Mazhuvancherry Kesavan Unnikrishnan; Mohan K Manu; Alian A Alrasheedy; Brian Godman; Donald E Morisky

doi:10.1016/j.sapharm.2017.10.008

Structured pharmacist-led intervention programme to improve medication adherence in COPD patients: A randomized controlled study

Res Social Adm Pharm. 2018 Oct;14(10):909-914. doi: 10.1016/j.sapharm.2017.10.008. Epub 2017 Oct 26.

Authors

Suhaj Abdulsalim¹, Mazhuvancherry Kesavan Unnikrishnan², Mohan K Manu³, Alian A Alrasheedy⁴, Brian Godman⁵, Donald E Morisky⁶

Affiliations

¹ Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, 576104, Manipal, India; Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Electronic address: a.suhaj@gmail.com.
² Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, 576104, Manipal, India; Department of Pharmacology, National College of Pharmacy, Manasseri, Kozhikode, Kerala, India. Electronic address: unnikrishnan.mk@nationalcollegeofpharmacy.org.
³ Department of Pulmonary Medicine, Kasturba Medical College Hospital, Manipal University, 576104, Manipal, India. Electronic address: manumohan73@gmail.com.
⁴ Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Electronic address: Alian-A@hotmail.com.
⁵ Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden; Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK. Electronic address: Brian.Godman@ki.se.
⁶ Distinguished Chair Professor at Kaohsiung University, Taiwan; Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, USA. Electronic address: dmorisky@ucla.edu.

PMID: 29104008
DOI: 10.1016/j.sapharm.2017.10.008

Abstract

Background: COPD is characterised by a progressive airflow limitation in the lungs. However, adherence to therapy improves management of symptoms and delays disease progression. Therefore, patients' knowledge and awareness about the disease are important. Hence, pharmacist-led educational interventions could achieve this and improve medication adherence.

Objective: This study evaluated the effectiveness of a clinical pharmacist-led intervention on medication adherence in COPD patients in a teaching hospital.

Methods: In an open-labelled randomized controlled study at Kasturba Medical College Hospital, Manipal, India, patients were randomly assigned to two groups (Intervention group [IG] and Control group [CG]), and were matched for socio-demographics and clinical characteristics. Medication adherence was assessed by the Morisky, Green and Levine Medication Adherence Questionnaire (MAQ). In IG, pharmacist intervention placed emphasis on (1) compliance, (2) smoking cessation, (3) exercise, (4) inhaler use and (5) need for timely follow up. The MAQ assessment was repeated at 6, 12, 18 and 24 months. Data were analysed statistically by SPSS version 20.0.

Results: Out of 328 patients screened during March 2012 to June 2013, 260 were recruited. Of these, 206 completed the follow-up (98 in CG and 104 in IG). Medication adherence improved significantly after pharmacist intervention in IG at all follow-up time points (P < 0.001). It increased from 49% at the baseline to 80% after 24 months (P < 0.001). Carelessness about taking medicines was one of the main reasons for non-adherence in COPD patients, but was effectively reduced by the intervention.

Conclusions: This is the first randomized controlled trial in India that demonstrates the pivotal role of pharmacist-led educational intervention in improving medication adherence in COPD. Involving non-physician health professionals could be the best strategy, for resource-poor nations like India, because the current physician-centric healthcare has no emphasis on patient education and counselling.

Keywords: COPD patients; MAQ; Medication adherence; Pharmacist intervention; Randomized controlled study.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Exercise
Female
Humans
India
Male
Medication Adherence*
Middle Aged
Nebulizers and Vaporizers / statistics & numerical data
Patient Education as Topic*
Pharmacists*
Professional Role*
Pulmonary Disease, Chronic Obstructive / drug therapy*
Smoking Cessation
Surveys and Questionnaires