Pharmaceutical care interventions, their outcomes and patients’ satisfaction in antiretroviral drug therapy
Abstract Pharmacist’s interventions (also known as pharmaceutical care plans) are means of solving the drug therapy problems identified in pharmaceutical care. Outcomes are the results of pharmacists’ intervention activities. Patients’ satisfaction refers to patients’ feeling of fulfillment, pleasure or happiness with the services they have received. This study was designed to determine the types of pharmacist interventions applied in the pharmaceutical care of HIV patients receiving treatment at a tertiary hospital in southeast Nigeria, the types of outcomes of such interventions and level of patients’ satisfaction with their drug therapy. The components of the American society of health-system pharmacists (ASHP) guidelines on ‘standardized method for pharmaceutical care was used as a data collection instrument to evaluate, document and intervene in the antiretroviral therapy of about one thousand four hundred and seventy three (1,473) patients. The results showed significant reductions in the frequency of the various interventions and parameters measured after the interventions. The study concluded that pharmaceutical interventions influences patients’ adherence, optimizes their drug therapy and improves rational prescribing and care resulting in significant improvements in the outcomes of their treatment and levels of satisfaction. Keywords: Pharmacist Interventions, Outcomes, Pharmaceutical care, HIV/AIDS, Patient satisfaction
Copyright © 2013 by the Author(s) – Published by ISDS LLC, Japan
International Society for Development and Sustainability (ISDS)
Cite this paper as: Nwaozuzu, E.E., Okonta, J.M. and Aguwa, C.N. (2013), “Pharmaceutical care interventions, their outcomes and patients’ satisfaction in antiretroviral drug therapy”, International Journal of Development and Sustainability, Vol. 2 No. 1, pp. 430-444.
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International Journal of Development and Sustainability Vol.2 No.1 (2013): 430-444
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In 1987, pharmaceutical care was philosophically defined as a covenantal relationship between a pharmacist and a patient in which the pharmacist performs drug use control functions (with appropriate knowledge and skill) governed by the awareness of and commitment of the patient’s interest (Hepler, 1987).
Implementation of pharmaceutical care involves six (6) basic steps which includes establishment of a professional/therapeutic relationship, collection of patient-specific data, evaluation of data to identify health and drug related problems, development and implementation of pharmaceutical care plan (pharmacist’s intervention which could be patient - focused intervention or drug - focused intervention), evaluation of intervention and follow – up and documentation.
To effectively implement PC, a collaborative working relationship between the pharmacist and the physician must be developed. As such common obstacles such as boundary or turf concerns, communication breakdown, power issues, and lack of trust in another practitioners’ competence should be addressed (MacDonough and Doncette, 2001). Pharmacists must accept a responsibility to educate prescribers, patients, and payers about the extent and value of PC services. Precisely, pharmacists must build the demand for PC services at the same time they create the supply (MacDonough et at, 1998).
Pharmacist’s interventions (also known as pharmaceutical care plans) are means of solving the drug therapy problems identified in pharmaceutical care. Outcomes are the results of pharmacists’ intervention activities. Patients’ satisfaction refers to patients’ feeling of fulfillment, pleasure or happiness with the services they have received. Patient satisfaction with healthcare reflects the quality of services from the patients’ perspective. Its measurement can help evaluate the performance of health service delivery, identify patients who need additional attentions or targeted interventions and predict treatment adherence and outcomes (Goode et al, 2011).
In developed countries, measuring patient-reported outcomes and satisfaction is central to designing and evaluating modern healthcare services and delivery systems (Goode et al, 2011). Studies in these countries have also identified correlates and predictors of patient satisfaction with drug therapy, combined drug therapy and behavioral training in some disease conditions and these have been used to tailor treatments to improve patient satisfaction (Goode et al, 2011).
In the developing countries however, lots of research is being conducted on patient satisfaction with HIV/AIDS treatment (Goode et al, 2011). The levels of satisfaction and the associated factors varied across measures, sub-groups of patients, clinical stages, clinics, regions and healthcare systems making it essential to characterize these attributes in each setting (Goode et al, 2011).
The present study seek to determine the types of pharmacist interventions applied in the pharmaceutical care of HIV patients receiving treatment at a tertiary hospital in southeast Nigeria, the outcomes of such interventions and level of patients’ satisfaction with their drug therapy.
International Journal of Development and Sustainability Vol.2 No.1 (2013): 430-444
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This is part 4 of 4 from a study carried out using the method described below. Before the study, an application for ethical approval of the study was sent to the management of the medical centre used for the study and the approval was granted.
The components of the American society of health-system pharmacists (ASHP) guidelines on ‘standardized method for pharmaceutical care’ were designed into a data collection instrument which was used to evaluate, document and intervene in the antiretroviral therapy of about one thousand four hundred and seventy three (1,473) patients.
Data were collected from the patients’ prescription sheets, laboratory report forms, care/ART cards, and other relevant forms in their treatment folders. Other relevant information were also obtained from the patients through oral interview. The data collected at this stage formed the base-line/ pre - intervention data for the study.
After documentation of these base-line data, pharmaceutical care interventions were implemented where necessary and there included:
1. Patient education using a validated educational material applied uniformly to all the patients in the study.
2. Healthcare personnel education, counseling and discussions.
3. Recommendations for changes of drugs/regimens, change of drug dose interval, duration or dosage form, addition of more drugs, treatment of untreated conditions, implementation of non-drug therapy, patient referral.
4. Ensuring that patients do their laboratory tests.
5. Monitoring the laboratory test results and carrying out interventions where necessary.
6. Giving patients access to pharmacists any time they needed it i.e. maintaining constant communication between the patients and the pharmacists.
Then a repetition of the data collection and documentation above was done nine (9) months after the implementation of the pharmaceutical care interventions mentioned above. This data represents the post - intervention data. The two data sets (baseline / pre-intervention & post-intervention data) were then be collated, analyzed and compared to see if the interventions resulted in any significant differences in the occurrence of drug therapy problems.
Appropriate statistical analysis was also applied to the data using Microsoft Excel and SPSS tools. Inclusion and exclusion criteria used for the study were;
1. New patients were excluded from the study since they will have had no previous encounter with the system and so no existing data on them.
2. Patients selected were those who have received treatment, drugs and counseling from the hospital for at least nine (9) months (i.e. who have visited the hospital for at least three (3) times).
3. Both adults and children as well as males and females were involved in the study.
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