A MEDICATION ADHERENCE AND EFFECT OF PATIENT COUNSELLING IN HYPOTHYROIDISM PATIENTS: A RANDOMIZED CONTROL STUDY Randomized control study
Main Article Content
Keywords
Medication adherence, Patient Compliance, assessment of medication compliance.
Abstract
Introduction: Hypothyroidism is a common clinical problem worldwide requiring life-long thyroid hormone replacement therapy for most patients. For more than four decades, numerous researches on how to properly measure and quantify medication adherence have been conducted but none of them can be counted as the gold standard. Different tools have been designed and validated for different conditions, in different circumstances. Generally, measurements of medication adherence are categorized by the WHO as subjective and objective measurements.
Objectives: the aim of this study is to assess patient compliance and to find out the impact of patient counseling to improve compliance among hypothyroidism patients.
Methods: This randomized control research, which involved 88 hypothyroidism patients over the course of three visits, compared the levels of patient compliance in Group A, which received standard counseling, and Group B, which received advanced counseling.
Results Total 88 patients were included in the study 67 female and 21 were males among them 36 female and 8 males in group A and 31 female and 13 males in group B. Mean of age was 45 in total, 44.44 in group A and 45.44 in group B. Mean of duration of disease was 5.53 in total, 5.55 in group A and 5.44 in group B. Mean of No. of drugs prescribed is 2.32 in total, 1.88 in group A and 2.69 in group B respectively. The variables show that high adherence, medium adherence, and low adherence in Group A visit 1 shows 0(0%), 0(0%) and 44(100%), visit 2 shows 0(0%), 2(4.54%) and 42(95.45%), visit 3 has 0(0%), 10(22.72%) and 32(72.72%) respectively. Group B visit 1 has 0(0%), 0(0%) and 44(100%), visit 2 shows 0(0%),3(6.81%) and 41(93.1%) and visit 3 has 7(15.9%), 28(63.63%) and 9(20.45%) respectively. Above variables show that mean of medication adherence in group A 5.97, 4.27 and 3.25 in visit 1, 2 and 3 respectively, and Group B 5.83, 3.74 and 1.72. Reduction shows the improvement but Group B has more significant improvement then Group A.
Medication Adherence improvement in follow-up visits of group A and B has proven with the help of one-way ANOVA on the basis of p value as per Table and Group B in Table. Mean difference shows Group B has more significant difference comparatively Group A, which reveals that Advance Counselling has significant role in improvement of Adherence.
Conclusion: This study demonstrates the necessity of patient counseling for patients in the healthcare system on the gravity of the illness, medication understanding, and dosing schedules. This study also emphasizes the importance of clinical pharmacists for adequate patient counseling in every healthcare setting to enhance therapeutic results in the case of chronic illnesses.
References
2. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. (2000) 160:526–34. doi: 10.1001/archinte.160.4.526
3. Afghani-Lombardi F, Antonangeli L, Martino E, Vitti P, Maccherini D, Leoli F, et al. The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano survey. J Clin Endocrinol Metab. (1999) 84:561–66.
4. Gussekloo J, van Exel E, de Craen AJ, Meinders AE, Frölich M, Westendorp RG. Thyroid status, disability and cognitive function, and survival in old age. JAMA (2004) 292:2591–99. doi: 10.1001/jama.292.21.2591
5. Parle JV, Franklyn JA, Cross KW, Jones SC, Sheppard MC. Prevalence and follow-up of abnormal thyrotropin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol. (1991) 34:77–83. doi: 10.1111/j.1365-2265.1991.tb01739.
6. Jayakumar RV. Clinical Approach to Thyroid Disease. Supplement to Japi 2011;59:11–13.
7. Ambika GU, Sanjay K, Rakesh KS, et al. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocrinol Metab. 2013;17(4):647–652.
8. Ambika GU, Usha VM. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab. 2011;15(Supply 2): 78–81.
9. Wai YL, Paula F. Medication Adherence Measures: An Overview. BioMed Res Int. 2015;2015:1–12.
10. Gordis L. Epidemiology, fifth edition, Chapter 8 Randomized Trials: Some further Issues. Elsevier saunders. 2014:160.
11. Annavarapu K, Borra HL, Chakka RS, et al. Assessment of medication adherence and risk factors for hypothyroidism in South Indian Tertiary care hospital: a cross–sectional study. J Diabetes Metab Disord Control. 2019;6(3):60‒79. DOI: 10.15406/jdmdc.2019.06.00184
12. Shakya Shrestha S, Risal K, Shrestha R, Bhatta RD. Medication Adherence to Levothyroxine Therapy among Hypothyroid Patients and their Clinical Outcomes with Special Reference to Thyroid Function Parameters. Kathmandu Univ Med J. 2018;62(2): 129-37.