Authors (including presenting author) :
Chan KL(1)(2), Pang KT(1)(2), Lam KYB(1), Lee OYT(1), Cheung YT(2)
Affiliation :
(1)Department of Pharmacy, Tung Wah Hospital, Hong Kong,(2)School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
Introduction :
In Hong Kong, there were a total of 166355 episodes of stroke identified in public hospitals under Hospital Authority from 1999 to 2007, and 118414 of these cases were first-ever stroke episodes. Among the episodes of first-ever stroke, 70.2% of them were episodes of ischemic stroke. The estimated 10-year risk of stroke in patients aged 55 increases with multiple risk factors, including high blood pressure, diabetes mellitus, cigarette smoking, history of atrial fibrillation and cardiovascular diseases. Therefore, pharmacological therapies targeting the aforementioned risk factors such as anti-hypertensive drugs are important to prevent stroke recurrence. However, medication adherence may decline over time, leading to higher risk of stroke recurrence. Pharmacist is a healthcare professional that is in a good position to provide medication counselling. With the lack of local data describing the impact of pharmacist medication counselling on medication adherence of patients suffered from stroke, this project was designed with the objective to evaluate the impact of pharmacist medication counselling on medication adherence of patients experienced the first episode of ischemic stroke.
Objectives :
The objective was to evaluate the impact of pharmacist medication counselling on medication adherence of patients experienced the first episode of ischemic stroke.
Methodology :
Pharmacist medication counselling service was provided to patients who had experienced the first episode of ischemic stroke and attended Stroke Rehabilitation Out-patient Clinic in Tung Wah Hospital. In the pharmacist medication counselling service, pharmacists would provide a 15 to 20-minute medication counselling to patients, including the importance of medication adherence, goal and duration of pharmacological therapy, indications, dosage, administration, possible adverse medication reactions, storage of medications and home monitoring parameters, and other relevant aspects of self-care, at the same time assessing their medication adherence and knowledge by using the Morisky, Green and Levine (MGL) Adherence Scale and the Medication Knowledge Assessment Form respectively. All patients recruited in the study would receive usual medical care provided by medical doctors and nurses. After 30 days of pharmacist medication counselling and baseline assessment on medication adherence and knowledge, follow-up assessment of medication adherence and medication knowledge was performed by pharmacists via phone follow-up. The primary outcome was the change in Morisky, Green and Levine (MGL) Adherence Score before and after intervention. The secondary outcomes were the change in medication knowledge assessment score before and after intervention, and the patient satisfaction score on the service.
Result & Outcome :
A total of 78 patients were counselled in the first assessment by pharmacists with response rate of 97.5%, defined by the proportion of patients agreed to participate in the study. There were 2 patients rejected to participate in the study. Among the 78 subjects, there were 73 of them completed both the baseline assessment and phone follow-up. Among these 73 subjects, 43 subjects (58.9%), 17 subjects (23.3%) and 13 subjects (17.8%) had high, medium and low adherence at baseline respectively. At 30-day post-counselling phone follow-up assessment, 20 subjects (27.4%) showed an improvement in MGL Adherence Score, as evident by a decrease in MGL Adherence score; while 48 subjects (65.8%) and 5 subjects (6.8%) showed no change and a decline in medication adherence respectively. There was significant improvement in medication adherence (p< 0.001). Moreover, there were improvements in medication knowledge about time of administration (p=0.008), side effects (p< 0.001), management of side effects (p< 0.001) and management of missed dose (p< 0.001). In conclusion, pharmacist medication counselling improved medication adherence and medication knowledge in patients experienced the first episode of ischemic stroke.
