Oct-Dec, 2011 - Indian Journal of Pharmacy Practice

Indian Journal of Pharmacy PracticeAssociation of Pharmaceutical Teachers of IndiaEvaluation of the Impact of a Pharmaceutical Care Program for Diabetes Patients inNepal: A Preliminary Study1, 2 3 4 5Dinesh K.U* , Mohamed Izham M.I ,Alurkar V.M , Pranaya M1 2Department of Hospital and Clinical Pharmacy, Department of Pharmacology, Manipal Teaching Hospital / Manipal College of MedicalSciences, Pokhara, Nepal3College of Pharmacy, Qatar University, Doha, Qatar,4Department of Medicine, Manipal College of Medical Sciences/Manipal Teaching Hospital, Pokhara, Nepal5Department of Pharmacology, College of Medical Sciences, Chitwan, Bharatpur, NepalA B S T R A C TSubmitted: 2/11/2011Accepted: 19/11/20114Diabetes is a chronic disease condition characterized by hyperglycemia, which if uncontrolled leads to various short terms and long termcomplications. The prevalence rate of diabetes is high in Nepal and is expected to rise. This rise is due to low literacy rate, lack of publicawareness, lack of advanced healthcare facilities and sedentary life style. The contribution of pharmacists in diabetes management is so far notdocumented in Nepal. The aim of this preliminary study was to assess the knowledge, attitude and practice of diabetics, drug prescribingpattern, and the impact of pharmaceutical care program on glycemic control, direct cost involvement and patient satisfaction. The study wasprospective and interventional, in which newly diagnosed diabetes patients were enrolled. They were evaluated for their diabetes Knowledge,Attitude and Practice (KAP), and satisfaction level by administering the KAP and satisfaction questionnaires at baseline and after two monthspost intervention. The enrolled patients were divided in three groups, control group (n=10), test group-1 (n=11) and test group-2 (n=10). Thecontrol group patients went through their normal care . Both the intervention groups (test group-1 and test group-2) received pharmaceuticalcare emphasized on education and counseling about diabetes, importance of medication used and were provided with diabetes booklet, dietchart, medication calendar, while demonstration of diabetic kit was specially to test group-2 patients only. Total 31 patients were enrolled [maleswere 22 (70.96%)]. Large number of patients were in the age group of 51-60 years (n=11, 35.48%). Commonly prescribed drug class wasantidiabetics (n=36, 48%). Biguanides were commonly prescribed drug category accounting for 17 (47.22%) of the total antidiabetics.Significant improvement in blood glucose level was observed in test group patients in terms of knowledge (score of 7.112.32), attitude (score of14.77±3.23) and practice (score of 9±1.65 check decimal point) after intervention. The overall improvement in KAP scores were foundinsignificant in all the three group patients (P=0.012). Direct cost reduction was noted in all the three groups during their two months studyperiod. The satisfaction level was found significantly higher (P=0.008) in test group-2 patient among the three groups. Present study has showna positive impact of pharmaceutical care program among diabetics in terms of their KAP improvement. Improvement in the glycemic control andreduction in the prescription cost and economical burden was found after such program which increased the overall patients' satisfaction.Keywords: Diabetes mellitus, Direct cost, Drug prescribing pattern, KAP, Nepal, Pharmaceutical care, Satisfaction.INTRODUCTIONDiabetes is a chronic disease condition characterized by1hyperglycemia. In diabetes there is an increased insulindemand and reduction of insulin secretion in the body. Thisleads to abnormal carbohydrate, protein and lipid2metabolism. It is one of the most common chronic diseaseAddress for Correspondence:Dinesh K Upadhyay, Assistant Professor, Department of Pharmacology /Hospital and Clinical Pharmacy, Manipal College of Medical Sciences/ ManipalTeaching Hospital, Pokhara, Nepal.E-mail: dinesh17dec@rediffmail.com3condition seen in primary care. Diabetes causes disability,premature mortality, loss of productivity and increaseddemand of healthcare facilities. The prevalence rates ofdiabetes type-2 is rising much higher than type-1 and have4affected 6% of people between the age group of 20-79 years.Diabetes if uncontrolled can lead to microvascular andmacrovascular complications which can affect the patients'5, 6quality of life and lead to morbidity and mortalityThe management of type-1 depends upon insulin therapy andtype-2 diabetes is treated by oral hypoglycemic agents7(OHAs). The treatment of long term complications likeIndian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 49