ASSESSMENT OF PHARMACIST MEDIATED EDUCATION ON MEDICATION ADHERENCE BEHAVIOR IN TYPE 2 DIABETES MELLITUS PATIENTS IN SOUTH INDIAN RURAL POPULATION
Objective: To assess the influence of pharmacist mediated education on medication adherence behavior (MMAS-8) in rural patients with type 2 diabetes mellitus.
Methods: This is a prospective, randomized interventional study approved by the institutional ethics committee. Eligible type 2 diabetic patients with written informed consent were enrolled and randomized into control and test group. The MMAS-8 questionnaire was administered to all patients at baseline and three subsequent follow-ups. Patients in the test group received structured education at every follow-up, whereas the control group patients received education only at the final follow up. SPSS software was used to evaluate the data.
Results: Among the 72 patients enrolled, 35 were randomized into a control group and 37 into the test group. Majority of the study patients (65.2%) were males with an age range of 30 to 72 y and were from agriculture profession (34.72%) with school education (59.7%). The mean body mass index (BMI) of the study patients was 25.01. At baseline, the mean glycosylated hemoglobin (HbA1c) value of patients was 6.48Â±1.39% in the control group and 6.23Â±1.16% in the test group. During the last follow-up, a significant (p<0.05) improvement was observed in MMAS-8 scores in test group patients compared to control group patients which were supported by statistically significant (p<0.05) improvement in capillary blood glucose (CBG) values.
Conclusion: Pharmacist mediated structured education has shown a positive impact on medication adherence behavior of test group patients towards their disease management.
2. International diabetes federation. 6th edition. IDF Diabetes Atlas; 2013.
3. Sarah Wild, R Sicree. Global prevalence of diabetes. estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:5.
4. SS Gangwar, A Ahamed, I Patel. Assessment of medication knowledge and counselling in type 2 diabetes mellitus patients attending community pharmacy in rural North India. AJPSP 2013;4:47-57.
5. Malathy R, MP Narmadha, Ramesh S. Effect of a diabetes counselling programme on knowledge, attitude and practice among diabetic patients in erode district of South India. J Young Pharmacist 2011;3:65-72.
6. Stam DM, Graham JP. Important aspects of self-management education in patients with diabetes. Pharm Pract Manag Q 1997;17:12-25.
7. Mazzuca SA, Moorman NH, Wheeler Ml. The diabetes education study: a controlled trial of the effects of diabetes education. Diabetes Care 1986;9:1-10.
8. Mahesh PA, Parthasarathi G. Medication adherence, textbook of clinical pharmacy practice, essential concepts and skills. Parthasarathi G, Hansen KN, Nahata MC, Orient Longman, Pvt Ltd; 2004. p. 54-71.
9. SZ Inamdar, RV Kulkarni, SR Karajgi. Medication adherence in diabetes mellitus: an overview on pharmacist role. Am J Adv Drug Delivery 2013:3:238-50.
10. R Adepu, SM Ari. Influence of structured patient education on therapeutic outcomes in diabetes and hypertensive patients. Asian J Pharm Clin Res 2010;3:174-8.
11. Sapkota S, Brien JA, Greenfield J. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes-impact on adherence. Plos One 2015;10:1-17.
12. Morisky DE, Ang A, Krousel Wood M. Predictive validity of a medication adherence measure for hypertension control. J Clin Hypertension 2008;10:348-54
13. Berlowitz DR, Foy CG, Kazis LE, Bolin L, Conroy LB, Fitzpatrick P, Gure TR, et al. for the SPRINT Study Research Group. Impact of intensive blood pressure therapy on patient-reported outcomes: outcomes results from the SPRINT study. N Engl J Med 2017;377:733-44.
14. Morisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherence final response. J Clin Epidemio 2011;64:258-63.
15. KV Ramanath. Impact of clinical pharmacist provided patient education on qol outcome in type ii diabetes mellitus in rural population. Asian J Pharm Clin Res 2011;4:15-20.
16. R Adepu, A Rasheed. Effect of patient counselling on quality of life in type 2 Diabetes mellitus patients in two selected south Indian community pharmacies: a study. Indian J Pharm Sci 2007;69:519-24.
17. R Adepu, Betsy AB. Impact of community pharmacy-based patient education on quality of life in type 2 diabetes mellitus. Int J Phytomed 2009;2:43-51.
18. Shobana R, Snehalatha C. Dietary profile of Urban South Indians and its relations with glycaemic status. Diabetes Res Clin Pract 1998;42:181-6.
19. R Grant, K Kleinman, AS Adams. Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycaemic management. Diabetes Care 2007;30:4.