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94 | P a g e International Standard Serial Number (ISSN): 2319-8141

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International Journal of Universal Pharmacy and Bio Sciences 3(4): July-August 2014

INTERNATIONAL JOURNAL OF UNIVERSAL

PHARMACY AND BIO SCIENCES IMPACT FACTOR 1.89***

ICV 5.13*** Bio Sciences Research Article ……!!!

ASSESSMENT OF THE IMPACT OF PHARMACIST PROVIDED PATIENT

COUNSELING ON TREATMENT OUTCOMES AND QUALITY OF LIFE IN

HYPERTENSIVE AND DIABETES MELLITUS TYPE-II PATIENTS Dr.D.NagaSatishBabu,K.MallikarjunReddy, G.RaghavendraKumar,

D.Narasimharao,Dr.J.N.SureshKumar, T. Swarupa Rani

Department of Pharmacy practice, Narasaraopet Institute of Pharmaceutical Sciences, Narasaraopet,

Guntur (D.t) A.P.

KEYWORDS:

Pharmacists,

Hypertension, Blood

pressure, Blood sugar

level.

For Correspondence:

Dr. D.Naga Satish

Babu *

Address: Department of

Pharmacy practice,

Narasaraopet Institute of

Pharmaceutical Sciences,

Narasaraopet, Guntur

(D.t) A.P.

Email ID:

[email protected]

om

ABSTRACT

Pharmacists today are aware that the practice of pharmacy has evolved

over the years to include not only preparation and dispensing of

medication to patients but also interaction with patients and other health

care providers throughout the provision of pharmaceutical care. Health

related quality of life is increasingly viewed as a therapeutic outcome

and is gradually gaining the same level of importance as clinical or

physiological outcome parameters. (eg: blood pressure, blood sugar

levels) this study aimed to assess impact of pharmacist provided patient

education on treatment out comes, KAP& QOL of patients with

coexisting diabetes and hypertension. Our study confirms that

improvement in knowledge of the disease and its management had

positive impact on treatment outcomes and quality of life (PCS). At the

same time it is noticed that counseling had no effect on mental

component summary of the patient’s quality of life. This study thus

emphasis the impact of patient counseling on KAP & QOL in patient

with diabetes and hypertension.

mailto:[email protected]

mailto:[email protected]



INTRODUCTION:

The most important role of patient counseling is to improve quality of life and provide quality care

for patients. The occurrence of so called “drug misadventures1” (adverse effects, side effects, drug

interactions and errors in use of medication)and non adherence to treatment program reduce quality

of life and interfere with quality care.2Counseling is essentially a helping process. In order to help

patients, the pharmacist must also educate them about their illness and their medications. Thus

patient counseling can be stated as “patient medication counseling is pharmacist’s talking with

patients about the medications they are intended to take in order to educate them about medication

related issues and to help them get the most benefit from their medication.3

DIABETES MELLITUS:

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels

that result from defects in insulin secretion, or action, or both. Normally, blood glucose levels are

tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose

level. When the blood glucose elevates (for example, after eating food), insulin is released from the

pancreas to normalize the glucose level. In patients with diabetes, the absence or insufficient

production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that

although it can be controlled, it lasts a lifetime.

DIABETES WITH HYPERTENSION:

HYPERTENSION: It is a condition of high blood pressure i.e pressure of blood in arteries. Normal

blood pressure is 120/80mmHg.

Epidemiology: Diabetes and hypertension coexist in approximately 40 to 60% of patients with type 2

diabetes. Diabetics subjects have a 1.5 – 3 times increased prevalence of hypertension compared to

non-diabetics with 50% of adults with diabetes having hypertension at the time of diagnosis. The

coexistence of these two conditions is associated with increased risk of retinopathy, nephropathy,

and cardiovascular disease. Hypertension is twice as prevalent in diabetic compared with non-

diabetic patients. Hypertension is a major factor that contributes to the development of the vascular

complications of diabetes mellitus mellitus type II patients, which primarily include atherosclerosis,

nephropathy, and retinopathy. The mechanism of the pathophysiological effects of hypertension lies

at the cellular level in the blood vessel wall, which intimately involves the function and

interaction of

the endothelial and vascular smooth muscle cells. Both hypertension and diabetes mellitus alter

endothelial cell structure and function. In large and medium size vessels and in the kidney,

endothelial dysfunction leads to enhanced growth and vasoconstriction of vascular

smooth muscle

cells and mesangial cells, respectively. These changes in the cells of smooth muscle lineage play a

key role in the development of both atherosclerosis and glomerulosclerosis. In diabetic retinopathy,

http://www.medicinenet.com/script/main/art.asp?articlekey=17467





damage and altered growth of retinal capillary endothelial cells is the major

pathophysiological insult

leading to proliferative lesions of the retina. Thus, the endothelium emerges as a key target organ of

damage in diabetes mellitus; this damage is enhanced in the presence of hypertension.

Health Related Quality Of Life (HRQoL):

One of the most important goals of all health interventions is to improve the quality of life of persons

affected by disease.4 In the domain of physical health and illness, quality of life refers to

participant’s self-evaluation of health or on their perceived functional status and well-being. In

chronic conditions such as hypertension and diabetes, health-related quality of life (HRQoL) is an

especially important outcome, given their lifelong nature and the need for daily self-management.

HRQoL has been found to be poorer in diabetic participants than in the general population,

especially in the domains of self perceived physical health, while findings on domains of

psychosocial functioning vary between studies5. Hypertension has also been shown to be associated

with negative outcomes in HRQoL, especially in the domain of subjectively perceived general

health, although its impact on HRQoL is usually less adverse than that of other chronic diseases.

Although studies comparing the effects of different chronic diseases generally point to a conclusion

that hypertension has less adverse effects on HRQoL than diabetes, the magnitude of effect is more

in case of coexistence of diabetes and hypertension6.

Specific aims of the study include:

To provide information to the patients about the advances in the management of diabetes

mellitus type II and hypertension.

To assess the patient’s Knowledge, Attitude, Practice with respect to the disease.

To assess the quality of life and impact of patient counseling on it.

METHODOLOGY:

STUDY SITE:

The study was conducted in Department of Medicine, Mahatma Gandhi Medical Hospital,

Warangal, and Andhra Pradesh. It is a 1000 bedded multispecialty teaching hospital.

STUDY PERIOD: This study was performed for a span of 6 months from Nov2010-Apr-2011.

STUDY DESIGN:

1. It is a randomized prospective controlled study.

2. Patients selected were divided into control and test groups.

3. Patients in the test group were counseled and given information about the management of the

disease, whereas control group receive the information only at the end of the study.

4. The follow up was carried out over a period of six months in which the KAP and quality of

life of the patients was assessed.



5. The scores were evaluated and statistically analysed.

6. A comparative study is made between the control and test groups.

Selection of patients:

Inclusion criteria:

1. Patients with diabetes mellitus type-II and hypertension.

2. Patients with age group of above 20 years.

3. Outpatients and inpatients are included.

Exclusion criteria:

1. Patients with an age group below 20 years.

2. Patients with hepatic disease and patients undergone complicated surgeries.

3. Pregnant women and lactating mothers.

RESULTS:

Using inclusion and exclusion criteria a total of 55patients were enrolled in the study and were

randomized to control and test groups. Of the 55 enrolled 47patients (23 control and 24 test) who

completed all follow-up visits were included in analysis. The other 8 patients withdrew from the

study for unknown reasons.

DEMOGRAPHICS:

Age and Sex:

Out of 4t patients included in the study 19(40.43%) were female and 28(59.57) were male.

Graph 1: Sex Distribution

The age distribution was as follows

1. 30 to 40 years of age are 04 patients (12.1%)



50.57

40.43 MALE

FEMALE



4. 61 to 70 years of age are 11patients (19.5%)

5. 71 to 80 years of age are 01 patient (2.12%)

Graph 2: Age Distribution

KAP STUDY:

KAP questionnaire contains a total of 25 questions of which 18 are knowledge questions and 7 are

attitude/practice question7.

EFFECT OF PATIENT COUNSELING ON KNOWLEDGE OUTCOMES:

The mean knowledge scores for control group before counseling was 10.76±0.32 and after

counseling was 12.10±0.234.

The mean knowledge scores for test group before counseling was 9.7±0.317 and after counseling

was 11.95±0.5355.

Graph 3: EFFECT OF PATIENT COUNSELING ON KNOWLEDGE OUTCOMES

8.50%

27.60%

38.30%

23.45%

2.12%

AGE DISTRIBUTION PERCENTAGE

30-40

41-50

51-60

61-70

71-80

9.762 10.1

8.7

11.95

0

2

4

6

8

10

12

14

control test

Me

an k

no

wle

dge

sco

re

EFFECT OF PATIENT COUNSELING ON KNOWLEDGE OUTCOMES

pre counseling

post counseling



EFFECT OF PATIENT COUNSELING ON ATITUDE AND PRACTICE OUTCOMES:

The mean attitude /practice scores before counseling and after counseling were 3.51±0.2809,

4.210±0.2026 respectively for control group.

The mean attitude/practice scores before counseling and after counseling were 3.8±2.2, 5.1±0.1433

respectively for test group.

Graph 4: EFFECT OF PATIENT COUNSELING ON ATITUDE AND PRACTICE

OUTCOMES

QUALITY OF LIFE:

Quality of life results were expressed in terms of two meta scores: Physical Component Summary

(PCS), Mental Component Summary(MCS)

EFFECT OF PATIENT COUNSELING ON PHYSICAL COMPONENT SUMMARY (PCS):

The pre counseling and post counseling PCS mean scores were 42.48±.136, 44.77±1.342

respectively for control group.

The pre counseling and post counseling PCS mean scores were 44.19±1.342, 49.71±0.622

respectively for test group.

3.5713.81

3.2

5.1

0

1

2

3

4

5

6

control test

Me

an a

ttit

ud

e a

nd

pra

ctic

e s

core

EFFECT OF PATIENT COUNSELING ON ATTITUDE AND PRACTICE OUTCOMES

pre counseling

post counseling



Graph 5: EFFECT OF PATIENT COUNSELING ON PHYSICAL COMPONENT

SUMMARY (PCS):

EFFECT OF PATIENT COUNSELING ON MENTAL COMPONENT SUMMARY (MCS):

The MCS mean scores before counseling and after counseling were found to be 46.68±1.125,

46.33±0.910 respectively for control group.

The MCS mean scores before counseling and after counseling were found to be 47.78±1.761,

48.55±1.168.

Graph6: EFFECT OF PATIENT COUNSELING ON MENTAL COMPONENT SUMMARY

(MCS):

42.48

44.7744.19

49.71

38

40

42

44

46

48

50

52

control test

Me

an P

CS

sco

reEFFECT OF PATIENT COUNSELING ON QUALITY

OF LIFE (PCS)

pre counseling

post counseling

46.6846.33

47.78

48.55

45

45.5

46

46.5

47

47.5

48

48.5

49

control test

Me

an M

CS

sco

re

EFFECT OF PATIENT COUNSELING ON QUALITY OF LIFE (MCS)

pre counseling

post counseling



BLOOD PREESURE AND BLOOD SUGAR LEVELS:

EFFECT OF PATIENT COUNSELING ON BLOOD PRESSURE LEVELS (SYSTOLIC):

The mean systolic blood pressure levels were 150.8± 3.1, 146.0±2.34 for pre counseling and post

counseling control groups.

The mean systolic blood pressure levels were 145.8±2.32, 140.8±1.92 for pre counseling and post

counseling test groups.

Graph 7: EFFECT OF PATIENT COUNSELING ON SYSTOLIC BLOOD PRESSURE

EFFECT OF PATIENT COUNSELING ON BLOOD PRESSURE LEVELS (DIASTOLIC):

The mean diastolic blood pressure levels were 99.10±7.2., 94.7.±5.26 for pre counseling and post

counseling control groups.

The mean diastolic blood pressure levels were 105.4.±4.2, 90.5±5.4.0 for pre counseling and post

counseling test groups.

Graph 8: EFFECT OF PATIENT COUNSELING ON DIASTOLIC BLOOD PRESSURE

134

136

138

140

142

144

146

148

150

152

test control test control

pre counseling post counseling

145.8

150.8

140.8

146

889092949698

100102104106

TEST CONTROL TEST CONTROL

PRE COUNCELLING POST COUNCELLING

105.4

99.1 99.5

94.7



EFFECT OF PATIENT COUNSELING ON BLOOD SUGAR LEVELS:

The mean blood sugar levels before counseling are like FBS-140.6±1.93, RBS-174.4 ±6.5 and after

counseling were FBS-137±2.25, RBS-172.8±5.28for control group.

The mean blood sugar levels before counseling are like FBS-175.3±5.32, RBS-195.9±7.62 and after

counseling were found to be FBS-161.6±4.84, 170.0±7.05 for test group.

Graph 9: EFFECT OF PATIENT COUNSELING ON BLOOD SUGAR LEVELS (RBS+FBS)

CONCLUSION:

Health related quality of life is increasingly viewed as a therapeutic outcome and is gradually

gaining the same level of importance as clinical or physiological outcome parameters. (eg: blood

pressure, blood sugar levels) this study aimed to assess impact of pharmacist provided patient

education on treatment out comes, KAP& QOL of patients with coexisting diabetes and

hypertension. At base line all patients had poor knowledge and attitude towards their disease and

thus poor QOL (PCS, MCS). At the end of the study patients of test group received extensive

counseling regarding their disease and its management showed greater improvement in treatment

outcomes (blood pressure & blood sugar levels), KAP& QOL than in patients in control group. Our

study confirms that improvement in knowledge of the disease and its management had positive

impact on treatment outcomes and quality of life (PCS). At the same time it is noticed that

counseling had no effect on mental component summary of the patient’s quality of life. This study

thus emphasis the impact of patient counseling on KAP & QOL in patient with diabetes and

hypertension.

0

20

40

60

80

100

120

140

160

180

200

TEST CONTROL TEST CONTROL

PRE COUNSELING POST COUNSELING

195.9

174.4 170 172.8175.3

140.6

161.6

137

RBS

FBS



BIBLIOGRAPHY

1. Melainee J Rantucci, Pharmacists talking with patients: A guide to patient counseling, 2009.

2. Robert S Beandesley, Carole L Kimberlin,Communication skills in Pharmacy Practice, 2010.

3. G. Parthasarathi, Karin Nyfort-Hansen, Milap c Nahata, A Textbook of Clinical Pharmacy

Practice: Essential concepts and skills,2010:43 -53.

4. Charles Richard, Boddington Joyee, Hannah M, Individual quality of life: Approaches to

conceptualization and assessment, 1999.

5. International classification of functioning, disability and health: ICF World Health

Organisation, 2010.

6. Stuart R Walker, Rachel Roser, Quality of life Assessment: Key issues in the 1990’s,

1993,2007,2010.

7. K. Kaliyaperumal, Guidelines for conducting a Knowledge, Attitude and Practice (KAP)

study, http://laico.org/v2020resource/files/guideline_kap_Jan_mar04.pdf.

http://laico.org/v2020resource/files/guideline_kap_Jan_mar04.pdf

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