A psychometric assessment of the impact of pharmaceutical care intervention on health-related quality of life in patients with Asthma

Background For chronic health conditions, the traditional measures of disease impact such as prevalence, mortality and hospitalization rates may be inadequate in understanding the extent of the impact of the disease on the individual. Measuring Health-related Quality of Life (HRQoL) has a role in describing health outcomes, guiding and assessing clinical management, predicting health outcomes, formulating clinical policy and allocating health resources. Pharmaceutical care delivery stands a good chance of positively impacting the HRQoL of patients‘ significantly. This must however be accompanied by appropriate prescribing and the care delivery must be oriented around the chronic model of care. Objectives This study assessed the content and outcomes of counselling and education delivered by pharmaceutical service providers to patients, reviewed prescribing patterns of asthma medications and evaluated the impact of pharmaceutical care provision on HRQoL of patients with asthma. Methods A 26-item interviewer-administered questionnaire was used to collect patient pharmacy-exit data on 388 prescription encounters. Patient data were separated into chronic and acute health conditions groups and the content and outcomes of their counseling and education at the pharmacy were assessed in phase I of this study. In Phase II, 409 prescriptions were retrospectively reviewed against the recommendations of the national standard treatment guidelines from 4 health care facilities around the country. Prescriptions on previous visits were selected with a developed tool just before participants were seen by their physicians and reviewed for conformity with the recommendations of national treatment guidelines. In phase III, a prospective pre/post- intervention study of a cohort of 77 adult out-patients visiting specialist asthma clinics were assessed for HRQoL and peak expiratory flow rates one month after a pharmaceutical care intervention. The Pharmaceutical care intervention included education on the health condition, pharmacotherapy and self-management including correction of inhaler-use technique, where necessary and self-referral. iv Results Participants with chronic health conditions were not provided with the same counseling and education as their counterparts with acute health conditions. Less than 20% of participants from the two disease condition groups received precautionary information. Close to 15% of the participants in the chronic health group were informed about what to do in case they felt bad or reacted to any of their medications as against 10% of participants in the acute health group. Prescribing patterns for asthma medications indicated widespread discrepancies. Many patients were on step III medications, an indication that most of the asthma patients had moderate persistent condition. About 46% of participants on inhaled Salmeterol/Fluticasone combination therapy were on dosage regimens not recommended in the standard treatment guidelines. The Pharmaceutical care intervention led to a significant improvement in asthma specific quality of life and peak flow rates. The mean paired difference of the HRQoL for the patients with asthma post- pharmaceutical care intervention was 0.697+0.89. A t-test analysis of the means at 95% CI, yielded a t= 6.85 (p<0.05). The mean paired difference for peak expiratory flow rate post intervention was 17.533+63.705 and a t=2.384 (p=0.02 at 95% CI). Conclusion The contents and outcomes from patient education and counseling at the pharmacies did not reflect any discrimination between acute and chronic health conditions. Prescriptions for pharmacologic therapy of asthma contained widespread inconsistent patterns as compared to those in the standard treatment guidelines. At one month after pharmaceutical care intervention, patients with asthma showed significant improvements with regard to asthma-specific quality of life, peak flow and knowledge.

Source: KNUST