Oct-Dec, 2011 - Indian Journal of Pharmacy Practice

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Dinesh KU - Evaluation of the Impact of a Pharmaceutical Care Program for Diabetes Patients in Nepal: A Preliminary Study2hypertension, hyperlipidemia and ischemic heart disease indiabetics also required to prescribe large number of drugs forthese patients life long. The long term complications can becontrolled only if the patient maintains their tight glycemic8control by following advice provided by healthcareprofessionals. Pharmacist can play an important role in9patient counseling and education program of diabetics. Thepatients' satisfaction can be increased only if their healthrelated problems can be minimized by providing proper careto them by healthcare professionals.Diabetes increase the economy burden and reduces patients'10productivity. Disease awareness in a population is the cornerstone to formulate the strategy to decrease the prevalence rateof diabetes. Organizing counseling and educational programis the first step to increase the awareness and alertness in thepatients for the disease and reduce the risk of long termcomplications. This may lead to less prescription cost andreduces the economy burden to the patient.A large number of research have been done in counseling and11,12education of diabetics. Proper counseling and educationcan improve patients knowledge about diabetes and increase13attitude and practice. Knowledge and information can helppeople to assess their risk of diabetes and inspire them to take14charge of their disease. A study from Kenya had identified aserious deficiency of knowledge about diabetes among the15diabetes patients. Another study from Nepal stated thatproper knowledge and care management program canimprove the patient outcomes and prevent the early stage of16complications. A study done from India stated that propercounseling and education improves patient's perceptions,17attitudes and practices regarding diabetes.Nepal is a developing country in South Asia with a significantburden of diabetes. It is estimated that the diabetes burden in18Nepal will be increased up to 6,38,000 by the year 2025. Thestrong reason behind increased percentage of diabetes inNepal is low literacy rate, lack of public awareness, lack ofalertness and understanding for diabetes, lack of advancedhealthcare facilities, low socioeconomic status and sedentary5life style. These factors may increase the diabetes incidencein the country which may lead prescription overload and19irrational drug prescribing.Hence, this preliminary study was conducted to identify theimpact of pharmaceutical care program among diabetics andits effect on KAP outcomes, patients' glycemic control, drugprescribing pattern, and effect on patients' economy burdenand satisfaction.OBJECTIVES:The present study was carried out with the followingobjectives:1. To study the demographic details of newly diagnoseddiabetes patients enrolled in study.2. To evaluate the patients' knowledge, attitude and practiceabout diabetes.3. To study the pattern of drug prescribing among diabeticpatients.4. To study the impact of pharmaceutical care program onglycemic control of the study subjects.5. To study the direct cost incurred by diabetics in diabetesmanagement.6. To evaluate the patient satisfaction on the pharmaceuticalcare provided to them.METHODOLOGYStudy design: This study was a prospective, interventional,follow up study where the newly diagnosed diabetic patientsstwere enrolled in the study during their 1 day of hospital visitto the Medicine Department. The patients were divided intothree groups [Control group (CG), Test group-1(TG-1) andTest group-2 (TG-2)] on the basis of 1 to 1 enrollment method.The control group patients were on the normal care, while thetest group-1 and test group-2 patients were on pharmaceuticalcare apart from normal care given by the clinicians. Eachpatient was followed for two months during their treatmentschedule.Consent form: This form was prepared to get the writtenconsent from patients before enrolling them in the study. Thisform was prepared in English and translated into local Nepalilanguage.Study site: The study was carried out in medicationcounseling center (for out patients) and at the bed side forhospitalized patients in medicine ward, Manipal TeachingHospital (MTH), Phulbari, Pokhara, Nepal. MTH is an 825bedded multidisciplinary private tertiary care teachinghospital of Manipal College of Medical Sciences located inwestern region of Nepal with average bed occupancy of about250 patients and an average out patient flow of about 450 perday. The hospital consists of both clinical and non-clinicalspecialty departments. Manipal College of Medical Sciencesthhas been included in the 7 WHO lists of hospitals in thedeveloping world. The hospital provides healthcare service topatients of western and mid western region of Nepal.Study duration: This preliminary study was carried out forthe duration of six months from February 2009 to July 2009 atManipal Teaching Hospital.Indian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 50
Dinesh KU - Evaluation of the Impact of a Pharmaceutical Care Program for Diabetes Patients in Nepal: A Preliminary StudyStudy sample: Total 31 patients were enrolled during thestudy period. They were divided into three groups (controlgroup=10, test group-1=11 and test group-2=10) on the basisof 1 to 1 enrollment method.Inclusion and exclusion criteria: Newly diagnosed diabetespatients at MTH and visited to the medicine department of thehospital during the study period were included in the study.Both out patients and in-patient were included in the study.Only new diabetic cases were enrolled in the study to validatethe methodology. Pregnant, mentally incompetent andimmunocompromised patients were excluded in the study.The patients who were not interested in taking part in thestudy were also excluded.STUDY TOOLS:I) Sociodemography form: The aim for preparing this formwas to have patient sociodemography in details like name,age, gender etc. This form was first prepared in English andtranslated into local Nepali language.ii) Lab investigation documentation form: This form wasprepared to have all the clinical investigation details of thediabetes patients done on their first day visit to hospital andduring their follow ups.iii) Direct cost documentation form: This form wasprepared to have all details about patients' expenses for theirdisease management during the study period.iv) Prescribed medication documentation form: This formwas prepared to have all the details about medicationprescribed by clinician to diabetes patients during the studyperiod.v) Knowledge, Attitude and Practice (KAP)questionnaire: The KAP questionnaire consisted of 30questions (knowledge-18, attitude-5 and practice-7 relatedquestions). This questionnaire were prepared first in Englishand then translated into local language by the professionalexperts. The validation of the questionnaire was done byevaluating the questions by asking them to the diabeticpatients. KAP scores were obtained through SPSS-16 andCronbach's α was determined. The Cronbach's α forknowledge, attitude and practice was 0.88, 0.64 and 0.85,respectively. The face and content validity was also done bysending the questionnaire to the experts.vii) Patient satisfaction questionnaire: The satisfactionquestionnaire consisted of 16 questions. These questionswere first prepared in English and then were translated intothe local language by professional experts. Thesequestionnaires were evaluated by the patient to know theirunderstanding about the questionnaires and scoring was doneby 5 point Likert scale.viii) Diabetes information booklet: A diabetes informationbooklet was prepared in local Nepali language. This bookletcontains primary information about diabetes, itscomplications, precautions to be taken for diabetesmanagement and medication used for diabetes treatment.Some of the information given in diabetes booklet was alsopresented in pictorial form.ix) Diabetes complication chart: This chart was prepared tomake the patients aware about long term and short termdiabetes complication which they may get any time in theirlife if they do not control their diabetes. This chart consisted ofdifferent diabetes complications in pictorial form.x) Dietary chart: This dietary chart was prepared fordiabetics. This chart was having the information about totaldietary management like what to take and what not to take bythe diabetics. The food items were presented in the pictorialform and food plates were well defined in the chart.xi) Medication calendar: Medication calendar was preparedand used in the study to make the patient well aware about themedication consumption like when to take, how to take, howmuch to take and how long to take.xii) Diabetic kit: This kit was made especially for test group-2 patient to educate them about the pattern of blood flow indiabetics and non-diabetics. Diabetic kit consisted of twoglass tubes, one tube shown normal pattern of blood flow innon-diabetics and second tube shown pattern of blood flow(effect of more sugar in blood) in diabetics. Apart from this,the kit had a provision to explain about food (fatty and nonfatty)circulation in body and fate of sugar and fat in body byusing human circulatory system chart and using the differentsynthetic balls of different smaller shapes, sizes and colour.Scoring method for KAP questions: KAP questionnairesconsist of total 18 knowledge questions, 5 attitude questionsand 7 practice questions. The patients were scored for theirknowledge, attitude and practice. In case of knowledgequestion, each correct answer was scored as one (1) and aszero (0) for incorrect answer. In case of attitude questions,they are scored on the basis of 5 point Likert scale (stronglydisagree=1, disagree=2, undecided=3, agree=4 and stronglyagree=5). The practice questions are scored on the basis of 3point Likert scale (never=0, occasional=1 and frequent=2).The maximum possible scores for knowledge, attitude andpractice question are 18, 05 and 02, respectively.Scoring method of satisfaction questions: Patientsatisfaction questionnaires consist of total 16 questions.These questions were scored on the basis of 5 point Likertscale (very dissatisfied=1, slightly dissatisfied=2, neithersatisfied nor dissatisfied=3, slightly satisfied=4 and verysatisfied=5)Indian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 51
Page 1 and 2: Indian Journal of Pharmacy Practice
Page 3 and 4: Dear ReadersIndian Journal of Pharm
Page 5 and 6: Daxesh M P - Combating Antimicrobia
Page 13 and 14: J. Chang - India's Progress towards
Page 15 and 16: J. Chang - India's Progress towards
Page 17 and 18: Shobha C - Poison Information Cente
Page 25 and 26: Anantha Naik N -Health Related Qual
Page 33 and 34: Amrita P - Scenario of Pharmacovigi
Page 42 and 43: Satyanarayana V - Evaluation of the
Page 54 and 55: Dinesh KU - Evaluation of the Impac
Page 66 and 67: Pratham R - A Retrospective Study o
Page 70 and 71: Anoop P -Impact of Clinical Pharmac
Page 76 and 77: Singh B -Respiratory Tract Problems
Page 78 and 79: Singh B -Respiratory Tract Problems
Page 80 and 81: Mihir Y.P - Study of Prescribing Pa
Page 84 and 85: Ramanath K.V -Evaluation of the Imp
Page 86 and 87: Ramanath K.V -Evaluation of the Imp
Page 88 and 89: Instructions to AuthorsIntroduction
Page 90: Instructions to AuthorsElectronic j

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