Browsing by Author "Anguuo, L.N."

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    The effect of pharmacist-provided discharge counselling on medication knowledge and adherence among patients with cardiovascular diseases at Windhoek central hospital, Namibia
    (University of Namibia, 2022) Anguuo, L.N.
    Cardiovascular diseases (CVDs) are the leading cause of death globally and are a major contributor to reduced quality of life(1) . According to the World Health Organization (WHO), an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke. Over three quarters of CVD deaths take place in low- and middle-income countries. Sub-Saharan Africa is ravaged by a growing burden of CVDs (2). Hypertension (HTN) is one of the most important modifiable risk factors for cardiovascular disease. HTN, as well as, heart failure (HF) are common causes of premature morbidity and mortality. They account for about 7.5 million deaths worldwide every year, with 82% occurring in low- and middle-income countries (3). HTN is defined as persistently elevated arterial blood pressure with a systolic blood pressure more than 140 mmHg and diastolic blood pressure more than 90 mmHg (3). HTN is known as the “silent killer”, as uncontrolled HTN is often asymptomatic. Left untreated, HTN can lead to myocardial infarction, left ventricular hypertrophy, congestive HF, aneurysm, stroke, chronic kidney disease (HTN nephropathy), and HTN retinopathy (4). HF is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen (4). Both HTN and HF require lifelong use of medications to prolong life, prevent complications, and reduce hospitalizations (3). Health care workers should accompany lifelong therapy with counselling, education, and adherence support. As medication experts, pharmacist are best placed to provide this support. 2 Counselling can be valuable at any point of the patient care journey but the current study focuses on the discharge stage. During inpatient hospital stay, a patient’s medications are administered by nurses and adherence is usually maintained. However, upon discharge, the patient (or a family member) must take responsibility for medication adherence in order to achieve and maintain their health status. The safety and efficacy of medication therapy depends on the correct information being shared with and understood by patients about their medication and patient understanding of that information (5). Therefore, the pharmacist undertaking discharge counselling should possess adequate knowledge and should be an effective communicator, making use of verbal and non-verbal communication skills (5). During medication counselling patients are provided with advice and information on their medicines. Patient counselling may be verbal or written, performed on an individual basis or in groups, and provided directly to the patient or caregiver (6). One of the pharmacist’s responsibilities is to optimize the patient's medication therapy by promoting adherence through good medication counseling. Pharmacists are ideally placed to provide useful medication counselling to patients at the time of discharge due to their extensive knowledge of medications (7). Providing tailored educational counselling and adequate information about medications, such as medication indications and clear instructions on medication use, improves adherence and increases patient confidence, self-efficacy and understanding on how to take their medications (8). Previous studies suggest that direct pharmacist interaction with patients through medication reconciliation, discharge counselling, and post discharge phone calls decreases the number of adverse drug events (ADEs) and plays a positive role in transitional care (9). For example, a study done by Fernandez and colleagues on the effect of pharmacist interventions on antidepressant medication adherence in 3 outpatients concluded that patients who received a pharmacist intervention were over 60% more likely to adhere to their medication than those who did not (OR=1.6, [95% Cl 1.2 to 2.2]) (10). Furthermore, some studies(11,12) have demonstrated the benefits of interventions provided by pharmacists in improving adherence and other patient outcomes. In addition to improved adherence, pharmacists can play an important role in the prevention of readmissions by counselling patients and providing relevant medication information. A study by Jackevicius et al., showed that after acute myocardial infarction, nearly 24% of patients did not fill their medications within seven days of discharge, and one third of patients decided to stop at least one medication in the first month (13). The relationship between medication knowledge and medication adherence is complicated. Some studies suggest that improved medication knowledge improves adherence (14), although, other reports show that counselling has little or no effect on adherence (15). Providing counselling to in-patients is one of the important tasks of hospital pharmacists. This study evaluated the impact of pharmacist-provided discharge counselling on patients’ medication knowledge and adherence.