https://orcid.org/0000-0003-0280-3299
Abstract
Purpose
The role of specialized pharmacy services remains unexplored in clinical practice for hepatitis C patients in Pakistan. This study aimed to evaluate the impact of clinical pharmacy interventions on treatment outcomes, health-related quality of life (HRQoL), and medication adherence among hepatitis C patients.
Methods
A randomized control trial was conducted at two tertiary-care teaching hospitals in Pakistan. Hepatitis C patients who attended the outpatient clinics between October 2015 and September 2018 were randomized to two groups [usual care (UC) and pharmaceutical care (PC)] in a 1:1 ratio, applying simple envelope method. The PC group received pharmaceutical care led by a clinical pharmacist. The care that patients received included education and counseling on medication compliance, labeling of medication packs, and monitoring of adverse drug events, led by a qualified clinical pharmacist during the 15- to 20-minute monthly sessions, while the UC group received standard care at hospital, which did not involve clinical pharmacist input. Outcome measures, such as sustained virological response, HRQoL, and adherence rate (pharmacy data) were assessed at enrolment and distinct time intervals: 4 weeks, 8 weeks, and end of treatment.
Results
A total of 931 patients were included in the study (UC 466 and PC 465), with mean age 42.35±1.9 years. Sustained virological response at 12 weeks was achieved in 86.0% patients in the PC group, significantly (p<0.001) higher than the UC (69.3%) group. Fewer patients (9.9%) in the PC group reported mobility problems, significantly fewer (p<0.001) than the UC group (11.8%). Self-care, usual activity, pain, and depression were relieved significantly in the PC group compared to the UC group. The EuroQol visual analogue scale (baseline 56.1 of UC group versus 55.2 for PC group) was raised to 71.8 and 71.9 in the UC and PC groups, respectively. Medication adherence was significantly improved (p<0.001) in the PC group (88.6%) when compared to the UC group (77.9%, 95% CI 88.9%–91.9%).
Conclusion
Pharmacist-led clinical pharmacy interventions as part of multidisciplinary care had a significant impact on improving cure rates, HRQoL, and medication adherence for hepatitis C patients. This study suggests that clinical pharmacists should be incorporated into the multidisciplinary health-care team for care of hepatitis C patients.
Acknowledgments
We thank the Administration of Services, Institute of Medical Sciences, Lahore (SIMS), Pakistan and the Pakistan Institute of Medical Sciences, Islamabad (PIMS), Pakistan for their kind support. We are grateful to Professor Dr Muhammad Imran (consultant) and Jamshaid Iqbal (pharmacy technician) at SIMS, who supported during the data collection. The authors are thankful to Ms. Eleri Lougher, Principal Pharmacist Patient Services, Princess of Wales Hospital, UK for watchful insight into the final manuscript, proofreading, and suggestions for English-language improvement.
Ethics Approval and Informed Consent
Ethical approvals was obtained from the Ethical Review Board of PIMS Hospital, Islamabad (F.1-1/2015/ERB/SZABMU), SIMS (IRB/2017/333/SIMS), and the Bioethics Committee of Quaid-i-Azam University, Islamabad (DFBS/2015-248). Written consent was obtained from all patients before the start of interview.
Data Sharing
The appendix, statistical sheets, and data set will be available from the corresponding author at [email protected].
Author Contributions
All authors contributed to data analysis and drafting and revising the article. MA, FR, and SA contributed substantially in acquisition of data. VP and TR made the initial concept and design. Interpretation of data was conducted by SA, SU, and SH. The initial draft of the manuscript was written by SA and TR. Finally, all authors approved the manuscript prior to submission and agreed to be accountable for all aspects of the work.
Disclosure
The authors declare that they have no financial or conflict of interest.