Assessment Of Pharmacist Intervention On Depression Patients' Adherence And Clinical Outcomes In A Tertiary Care Centre At Riyadh, Saudi Arabia
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Date
2016-07
Authors
Al - Jumah, Khalaf Ali
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Abstract
Depression is a chronic mental illness with a significant disabling effect on the patient‘s quality of life. Depression lifetime prevalence reach up to 15% worldwide and up to 18% in Saudi Arabia. In general the effectiveness of antidepressants is reduced due to patients‘ non-adherence. This may result in serious consequences such as treatment failure, complications, high medical care utilization, and impairment in work functioning. The role of pharmacists in the healthcare system has expanded to include involvement in clinical trials, health economics, patient education, and direct patient care. Pharmacist interventions have proved to be beneficial in improving treatment outcomes in a variety of healthcare settings. Therefore, this research aims to evaluate the impact of a pharmacist intervention based on shared decision making to improve adherence to antidepressant medication and related patient outcomes. A cross-sectional descriptive analysis study was carried to describe depressed Saudi population with respect to adherence to antidepressant and to determine the risk factors and the association between adherence and other patient-related outcomes. Then, a prospective randomized controlled study, with six-month follow-up, was conducted to evaluate the impact of pharmacist intervention. A cross-sectional study was conducted on 403 patients. The result showed that 52.9% of the patients reported low adherence to antidepressant medication and average Morisky medication adherence scale score (5.23 out of 8) with statistically significant differences in adherence level in favour of males, older patients, patients with a shorter duration of illness, and those having more than three follow-up visits
with a psychiatric clinic per year. Regarding the predictors of adherence to antidepressant, the result showed that the concerns beliefs (R = 0.40; P < .001 R2 = 0.162) was the most important predictor associated with adherence to antidepressants. In the randomized controlled study, 239 patients met the inclusion criteria and were assigned to the intervention group (n = 119) and the control group (n = 120). However, 19 patients dropped out of the study during the follow-up phase. After 6 months, patients in the intervention group showed statistically significant differences in adherence to medication, treatment satisfaction, general overuse beliefs, specific concerns beliefs and the total general beliefs about medicines compared with those in the control group. However, no statistically significant difference was observed between the two groups in terms of severity of depression and health-related quality of life. In conclusion, pharmacist intervention based on shared decision making with depressed patients showed a significant improvement in adherence, treatment satisfaction and patients‘ belief of antidepressants compared with patients having the usual care. Thus, this finding suggests that the pharmacist role can be enhanced to provide direct patient care in psychiatric and in regular pharmacy practice to improve adherence to medication and other patients reported outcomes.
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The pharmacist role can be enhanced to provide , direct patient care in psychiatric.