IMPACT OF CONTINUOUS PATIENT COUNSELLING ON KNOWLEDGE, ATTITUDE, AND PRACTICES AND MEDICATION ADHERENCE OF DIABETIC PATIENTS ATTENDING OUTPATIENT PHARMACY SERVICES
Abstract
ABSTRACT
Objective: The morbidity and morbidity associated with diabetes can be drastically reduced by the knowledge about diabetes mellitus and appropriate
attitude toward the disease. A study was conducted to assess the level of knowledge, attitude, and practices (KAP) and medication adherence patterns
of diabetic patients and effect of pharmacist‑led patient education on KAP and medication adherence patterns in these patients.
Methods: 400 diabetic patients of either sex, aged above 18 years were divided randomly into two groups of 200 each as control and the intervention
groups. At the baseline, patients in both the groups were assessed for KAP using KAP Questionnaire and medication adherence using Morisky
Adherence Questionnaire. Patients in the intervention group were counseled both verbally and by distribution of a patient education leaflets at baseline
and at three consecutive follow‑ups (1
st
, 2
nd
, and 3
months), and patients in the control group were counseled both verbally and by distribution of
patient education leaflets at the baseline and then on the follow‑up after 3 months. Both the groups were assessed repeatedly for KAP and medication
adherence using same questionnaires after each counseling sessions. The mean scores of KAP and medication adherence, and the fasting blood sugar
levels (FBS) at the baseline and on the follow‑up for control and the intervention groups were analyzed statistically using independent sample t‑test
and Mann–Whitney U‑test.
rd
Results: Of 200 patients in each group, 178 females and 22 males in the intervention group (mean age 57.80±9.878 years) and 179 females and
21 males in the control group (mean age 57.57±9.438 years). A statistically significant improvement in the mean KAP and adherence scores was
observed from the baseline to the final follow‑up in both groups (p≤0.001). The increase in the KAP and medication adherence scores from baseline
to the follow‑up in the intervention group was found to be significantly higher than the control group. There was a reduction in the mean FBS from
baseline to the follow‑up in both the groups but a statistically significant higher reduction in the mean FBS was found in the intervention group from
baseline to the final follow‑up when compared to the control group (p < 0.001).
Conclusion: A better KAP of diabetic patients about their disease can improve the medication adherence behavior which in turn can improve clinical
outcomes. The patient education should be a continuous process, and patients should be assessed at every subsequent visit for medication adherence
to achieve better health outcome.
Keywords: Diabetes, Adherence, Knowledge, attitude and practices, Patient education.
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References
REFERENCES
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of
diabetes: Estimates for the year 2000 and projections for 2030. Diabetes
Care 2004;27(5):1047‑53.
International Diabetes Federation. Diabetes Atlas. 3
ed. Brussels,
Belgium: International Diabetes Federation; 2006.
rd
Christensen DL, Friis H, Mwaniki DL, Kilonzo B, Tetens I, Boit MK,
et al. Prevalence of glucose intolerance and associated risk factors
in rural and urban populations of different ethnic groups in Kenya.
Diabetes Res Clin Pract 2009;84(3):303‑10.
King H, Aubert RE, Herman WH. Global burden of diabetes,
‑2025: Prevalence, numerical estimates, and projections. Diabetes
Care 1998;21(9):1414‑31.
Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of
type 2 diabetes: Indian scenario. Indian J Med Res 2007;125(3):217‑30.
Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A,
et al. Awareness and knowledge of diabetes in Chennai – The Chennai
Urban rural epidemiology study [CURES‑9]. J Assoc Physicians India
;53:283‑7.
Pradeepa R, Mohan V. The changing scenario of the diabetes epidemic:
Implications for India. Indian J Med Res 2002;116:121‑32.
Katulanda P, Constantine GR, Mahesh JG, Sheriff R, Seneviratne
RD, Wijeratne S, et al. Prevalence and projections of diabetes and
pre‑diabetes in adults in Sri Lanka – Sri Lanka diabetes, cardiovascular
study (SLDCS). Diabet Med 2008;25:1062‑9.
Praveen Kumar NV, Mohanta GP, Manna PK, Manavalan R. Body
mass index – A diagnostic tool to assess obesity. Indian J Pharm Pract
;2(2):81‑3.
Diabetes mellitus and exercise. American Diabetes Association.
Diabetes Care 1997;20(12):1908‑12.
Adetuyibi A. Diabetes in the Nigerian African. III. Socioeconomic
aspects. Trop Geogr Med 1976;28(3):165‑8.
Lushen M, Rambiritch V. An assessment of the level of knowledge
about diabetes mellitus among diabetic patients in a primary healthcare
setting. S Afr Fam Pract 2007;49(10):16a‑16d.
Upadhyay DK, Palaian S, Shankar PR, Mishra P. Knowledge, attitude
and practice about diabetes among diabetes patients in western Nepal.
Rawal Med J 2008;33(1):8‑11.
Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, et al.
National standards for diabetes self‑management education. Diabetes
Care 2007;30(4):1630‑7.
Krapek K, King K, Warren SS, George KG, Caputo DA, Mihelich K,
et al. Medication adherence and associated hemoglobin A1c in type 2
diabetes. Ann Pharmacother 2004;38(9):1357‑62.
Briesacher BA, Andrade SE, Fouayzi H, Chan KA. Comparison of drug
adherence rates among patients with seven different medical conditions.
Pharmacotherapy 2008;28(4):437‑43.
Lewis RK, Lasack NL, Lambert BL, Connor SE. Patient
counselling – A focus on maintenance therapy. Am J Health Syst Pharm
;54(18):2084‑98.
Palaian S, Acharya LD, Madhva Rao PG, Shankar PR, Nair NM,
Nair NP. Knowledge, attitude, and practice outcomes: Evaluating the
impact of counselling in hospitalized diabetic patients in India. P&T
;31(7):383‑95.
Morisky DE, Green LW, Levine DM. Concurrent and predictive
validity of a self‑reported measure of medication adherence. Med Care
;24(1):67‑74.
Hawal NP, Shivaswamy MS, Kambar S, Patil S, Hiremath MB.
Asian J Pharm Clin Res, Vol 9, Issue 1, 2016, 364-369
Renuga et al.
Knowledge, attitude and behaviour regarding self‑care practices among
type 2 diabetes mellitus patients residing in an urban area of South
India. Int Multidispl Res J 2012;2(12):31‑35.
Malathy R, Narmadha MP, Ramesh S, Alvin Jose M, Dinesh Babu N.
Effect of a diabetes counselling programme on knowledge, attitude
and practice among diabetic patients in Erode district of South India.
J Young Pharm 2011;3(1):65‑72.
Ramanath KV, Santhosh YL. Impact of clinical pharmacist provided
patient education on QOL outcome in type II diabetes mellitus in rural
population. Asian J Pharm Clin Res 2011;4(4);15‑20.
Al‑Maskari F, El‑Sadig M, Al‑Kaabi JM, Afandi B, Nagelkerke N,
Yeatts KB. Knowledge, attitude and practices of diabetic patients in the
United Arab Emirates. PloS One 2013;8(1):e52857.
Adepu R, Rasheed A, Nagavi G. Effect of patient counselling on
quality of life in Type‑2 diabetes mellitus patients in two selected
south Indian community pharmacies: A study. Indian J Pharm Sci
;69(4):519‑24.
Adepu R, Ari SM. Influence of structured patient education on
therapeutic outcomes in diabetes and hypertensive patients. Asian J
Pharm Clin Res 2010;3(3):174‑8.
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