IMPACT OF PHARMACIST INTERVENTION ON MEDICATION KNOWLEDGE AND ADHERENCE IN HEMODIALYSIS PATIENTS

Objective: The objectives of the study are to evaluate the medication knowledge and medication adherence in patients undergoing haemodialysis and to educate the patients regarding the importance of medication adherence through counseling by providing Patient Information Leaflets and to analyze its impact. Methods: 50 Patients were randomly divided into two groups (control and test). Patient data was collected and documented using the patient data collection form after obtaining their consent. Their knowledge and medication adherence were assessed using questionnaires and was quantified. Patients included in the test group were counseled using Patient Information Leaflets whereas the control group was not counseled. Re-assessment was done during follow up for both groups. Results: Paired t-test was done to check if there was a significant difference in both the test and control group, with and without the use of Patient Information Leaflets respectively. The study showed that the test group had significant improvement (P<0.05) in their medication adherence and knowledge whereas there was no significant change in the control group. Conclusion: Providing patient counseling and continuous education with efforts to improve awareness among haemodialysis patients could enhance adherence to therapies and thus could improve clinical outcomes and quality of life

A PROSPECTIVE STUDY ON GERIATRIC PRESCRIBING PATTERN AND MEDICATION ADHERENCE IN A TERTIARY CARE HOSPITAL

  Objectives: To identify potentially inappropriate medications (PIMs) using Beers criteria 2015 and to recommend safer alternative medication for the above. To assess the medication adherence in geriatric patients and to categorize according to their adherence.Methods: This is prospective, interventional study. A total of 90 patients aged 65 years and above were involved in the study. Data were collected and recorded. The prescriptions were analyzed for appropriateness using updated Beers criteria 2015 and assess medication adherence using 8-item Morisky questionnaire.Results: Majority of the patients were in the age group of 65-74 years. Males (53%) showed predominance than females. The highest rate of (53%) polypharmacy was found in general medicine department than other departments. Out of 147 disease conditions observed, chronic renal failure (21.1%) was the most common condition. A total of 66 patients had comorbid conditions. Most frequently prescribed medications belonged to cardiovascular drugs (56; 14.62%). A total of 46 patients received PIMs; majority belonged to Category 1 - amitriptyline. Commonly prescribed medication in PIMs belonged to central nervous system medications (20%). Majority of patients were low adherent (51.11%) in which female patients showed preponderance in low adherence.Conclusion: Study showed prevalence of disease pattern, medication use, polypharmacy, PIMs, and medication adherence. It is important for pharmacists to stay updated and prescribers need to be educated and encouraged about Beers criteria for rational prescription for better pharmaceutical care and increased medication adherence

ASSESSMENT OF OSTEOPOROSIS AND ANAEMIA RISK IN PATIENTS ON ANTICONVULSANT THERAPY

Objective: To assess the incidence of osteoporosis and anaemia in patients on anticonvulsant therapy and to educate those under risk.Methods: A prospective observational study was conducted on 50 study participants. The Bone mineral density (BMD), vitamin D, hematological parameters and peripheral smear were noted. Data analyzed using different statistical methods. Patient information brochures for osteoporosis and anaemia were distributed to those on chronic anti-epileptic drug (AED) therapy.Results: The prevalence of osteoporosis was 16% and osteopenia 22%. The BMD of subjects showed an Insignificant reduction in BMD when compared with a standard reference value for south asian population (*P>0.05). The mean BMD in single therapy group was higher compared with multiple therapy groups. BMD of the enzyme-inducing class was less compared with non-enzyme inducing class but was not significant (P>0.05). Duration of therapy was compared with BMD of patients showed a negative correlation. The relationship between duration of therapy and hematological parameters showed a negative correlation (r =-0.128). The mean haematological parameters in single AED therapy were higher when compared with multiple AED therapy. The study demonstrated 40% microcytic hypochromic and 4% macrocytic hypochromic morphology.Conclusion: Chronic therapy with AEDs possesses a significant risk of developing osteoporosis and anaemia. The incidence rate varies according to the type, duration, and mode of therapy. Early detection and management through diet exercise or pharmacotherapy will decrease the incidence of unwanted effects due to AEDs and improve the quality of life.Keywords: Bone mineral density, Antiepileptic drug, Osteoporosi

Comparison of medication adherence in patients with type 2 diabetes mellitus: a pre and post study

Background: Type 2 diabetes mellitus refers to a group of heterogeneous disorders with the common elements of chronic hyperglycemia. Diabetes medications play a crucial role in lowering blood sugar levels. The study aims to compare medication adherence in patients with type 2 diabetes mellitus from urban and rural areas during pre and post visit. Methods: This pre and post-study was conducted from March to August 2022. A total of 104 participants were enrolled. Details have been obtained through data collection form. Medication adherence was measured using Hill-Bone medication adherence scale, and patient education was provided through leaflet. Results: The study included 54 females and 50 males. The correlation between medication adherence versus disease knowledge and drug knowledge was found out using Pearson’s correlation and the result is statistically significant. The medication adherence was found to be increased by 17.3% and 21.2% in rural and urban areas respectively. Inadequate follow-up and financial barriers were most accounted for medication non-adherence. Conclusions: The majority of type 2 diabetes patients have suboptimal treatment adherence which is associated with poor blood sugar control. We clinical pharmacists can tackle this problem of adherence through quality patient education

A STUDY ON PATIENTS' AWARENESS, RECOGNITION MANAGEMENT AND PREVALENCE OF HYPOGLYCEMIC EPISODES IN TYPE 2 DIABETES MELLITUS IN A TERTIARY CARE HOSPITAL

Objective: To assess patients' awareness on management of hypoglycemic episodes and analyzing the prevalence of hypoglycemic episodes inpatients with Type 2 diabetes mellitus.Methods: A prospective-observational comparative study was carried out for a period of 6 months in the outpatient unit of endocrinology and generalmedicine department. Patients who had hypoglycemic episodes were classified into mild, moderate and severe hypoglycemia with respective toage, anti-diabetic therapy and co-morbidities. Prevalence of hypoglycemia was calculated using prevalence formula; hypoglycemic episodes for antidiabetictherapy were compared using ANOVA and independent t-test.Results: Of 200 patients, (43%) were male and (57%) were female patients. Patients with systemic hypertension (30%) were more predominant thanother co-morbid conditions. According to anti-diabetic therapy (49.5%) patients were on oral hypoglycemic agents (OHA's), (16.5%) on insulin and(34.5%) on both insulin and OHA's. The calculated value of t (2.831) was greater than table value (2.45) and mean of OHA (24.75) was greater thanthe mean of insulin (8.25). Prevalence of hypoglycemia was (51%).Conclusion: The results from this study showed that more number of patients taking OHAs was found to experience hypoglycemia and patients withSHT as co-morbid condition were found to experience hypoglycemia than other co-morbid conditions. Prevalence of hypoglycemia was found to bemore in females and elderly population.Keywords: Hypoglycemic episodes, Prevalence, Insulin, Oral hypoglycemic agents, Co-morbid condition

A STUDY ON DRUG UTILIZATION EVALUATION AND POTENTIAL DRUG RELATED PROBLEMS IN TYPE-2 DIABETES MELLITUS PATIENTS WITH CO-MORBIDITIES IN A TERTIARY CARE HOSPITAL

Objective: The objective of this study is to evaluate prescribing pattern, analyze drug-related problems, identify co-morbidities and complications in Type 2 Diabetes Mellitus patients and also to perform cost analysis of Biguanides, Sulfonylureas, Dipeptidyl Peptidase Inhibitors Methods: A Prospective observational study was done in General Medicine and Endocrinology Departments of PSG Hospitals. A total of 200 study subjects, including both inpatients and outpatients, above 18 y of age, prescribed with OHAs (Biguanides, Sulfonylureas and DPP4 inhibitors) were included in the study. Results: Diabetes was more prevalent among males. OHAs were most prescribed in the age group of 51-60 y. Hypertension (71%) was the most common comorbidity and Diabetic neuropathy (23%) was the most common complication found in the patients. Multidrug therapy (72.5%) was most prescribed in diabetic patients, followed by Biguanides. Hypoglycemia was the most prevalent ADR. Cost analysis showed that T. Linagliptin was of high cost and T. Glimepiride being the low cost. Using WHO core indicators prescribing patterns were assessed. Feedback was collected and results were reported to the physicians which showed rational utilization of drugs. Conclusion: The study on drug utilization conducted in a tertiary care hospital helped us to find out that prescribing trends seems to be progressing towards combination therapy, predominantly two-drug therap

Skeletal maturity and socio-economic status in portuguese children and youths: the Madeira growth study

Skeletal maturity is used to evaluate biological maturity status. Information about the association between socio-economic status (SES) and skeletal maturity is limited in Portugal. Aims: The aim of this study is to document the skeletal maturity of youths in Madeira and to evaluate variation in maturity associated with SES. Subjects and methods: The study involved 507 subjects (256 boys and 251 girls) from the Madeira Growth Study, a mixed-longitudinal study of five cohorts (8, 10, 12, 14 and 16 years of age) followed at yearly intervals over 3 years (1996–1998). A total of 1493 observations were made. Skeletal age was estimated from radiographs of the hand and wrist using the Tanner–Whitehouse 2 method (TW2). Social class rankings were based on Graffar’s (1956) method. Five social rankings were subsequently grouped into three SES categories: high, average and low. Results: Median for the radius, ulna and short finger bones (RUS scores) in the total sample of boys and girls increased curvilinearly across age whereas median for the 7 (without pisiform) carpal bones (Carpal scores) increased almost linearly. The 20-bone maturity scores demonstrated distinctive trends by gender: the medians for boys increased almost linearly while the medians for girls increased curvilinearly. SES differences were minimal. Only among children aged 10–11 years were high SES boys and girls advanced in skeletal maturity. Madeira adolescents were advanced in skeletal maturity compared with Belgian reference values. Conclusion: The data suggests population variation in TW2 estimates of skeletal maturation. Skeletal maturity was not related to SES in youths from Madeira

EFFECT OF MEDICATION RELATED EDUCATIONAL INTERVENTIONS ON IMPROVING MEDICATION ADHERENCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

  Objectives: To assess the patient medication adherence using 8 item morisky medication adherence scale (MMAS). To categorize patients based on their adherence to antidiabetic medications into low, medium, and high adherent. To provide educational interventions such as patient counseling using teach-back method, patient medication information leaflet, and audio-visual aids and thus to improve the patient medication adherence.Methods: After obtaining informed consent from the patients, data of the patients were recorded in data collection forms. Their adherence to antidiabetic medication was evaluated using 8 item MMAS and patients were categorized into low, medium, and high adherence groups based on the score. Counseling was done based on the categorization (high, medium, and low). During review, again adherence was rechecked using 8 item MMAS.Results: Medication adherence was measured using 8 item MMAS on review and adherence was found to be improved using different patient counseling methods according to their adherence category. Improvement in score within low adherence group was found to be 83.87%; improvement of the low adherence group to medium adherence group was 16.12%. Improvement within the medium adherence group was 82.14% and from medium adherence to high adherence group was 17.85%.Conclusion: Patient counseling can improve adherence in type 2 diabetes mellitus patients, which in turn help patients in achieving optimal glycemic control

ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function