The effect of pharmacist-provided discharge counselling on medication knowledge and adherence among patients with cardiovascular diseases at Windhoek central hospital, Namibia
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Date
2022
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Publisher
University of Namibia
Abstract
Background: Pharmacists are ideally placed to provide medication counselling to patients during the discharge stage of the patient care journey due to their extensive knowledge of medications. The provision of tailored educational counselling and adequate information about medications may improve patients’ adherence, level of confidence, self-efficacy, and understanding of how to take their medications. Objectives: To pilot the implementation of a pharmacist-provided discharge counselling service and to measure patients’ level of medication knowledge and adherence before and after implementation of the service. Methods: A prospective quasi-experimental study was completed among adult patients with cardiovascular diseases admitted to Windhoek Central Hospital during between November 2020 and May 2021. Patients taking at least one chronic medicine prior to admission and at discharge were included in the study. The study comprised of a control phase prior to implementation of the pharmacist-provided discharge counselling service and an intervention phase following implementation. Each phase was 3 months long with a one-month period between the two phases that was devoted to educational programmes. Patients in the intervention group received discharge counselling by trained pharmacists while patients in the control group received usual care. Patients’ level of medication adherence and medication knowledge were assessed through interviews within a day of admission and on days 7 and 14 post-discharge. Repeated measures analysis of covariance was used to compare the level of medication knowledge and adherence among patients in the control and intervention groups. A p < 0.05 was considered statistically significant. Results: A total of 84 patients comprising 42 patients in each group were evaluated. Female patients accounted for 59.5% (25/42) and 69.0% (29/42) of the patients in the control and intervention group, respectively. The mean age of patients in the control group was 45.5 years (range: 18-80 years) compared to 39.3 years (range: 18-69 years) in the intervention group. After controlling for the level of adherence at admission, there was a statistically significant difference in the levels of patient adherence to medication on days 7 and 14 post discharge as a consequence of pharmacist-provided counselling, (F (1, 81) = 110.626, p < 0.001, ηp2 = 0.577). Estimated marginal means of adherence levels were different in the control (M = 80.273, SE = 0.46) and intervention (M = 87.14, SE = 0.46) groups. The level of adherence at admission was significantly related to the levels of adherence on days 7 and 14 post-discharge, F (1, 81) = 126.35, p < 0.001, ηp2 = 0.609). In addition, there was no significant difference in the levels of adherence measured on days 7 and 14 after discharge from hospital, F (1, 81) = 0.030, p = 0.862, ηp2 = 0.001). After controlling for patient’s level of medication knowledge at admission, there was a significant effect of pharmacist-provided counselling on the levels of patients’ medication knowledge measured on days 7 and 14 post-discharge, (F (1, 81) = 41.49, p < 0.001, ηp2 = 0.339). Estimated marginal means of levels of knowledge were different in the control (M = 62.20, SE = 0.72) and intervention (M = 68.76, SE = 0.72) groups. The level of medication knowledge at admission was significantly related to the levels of medication knowledge on days 7 and 14 post-discharge, F (1, 81) = 273.79, p < 0.001, ηp2 = 0.772). Furthermore, there was a significant difference in the levels of medication knowledge measured on days 7 and 14 after discharge from hospital, F (1, 81) = 9.03, p = 0.004, ηp2 = 0.1). ii Conclusions: Implementation of a pharmacist-provided discharge counselling service resulted in improvements in the level of medication knowledge and adherence among patients.
Description
A thesis submitted in partial fulfilment of the requirements for the Degree of Master of Pharmacy (Clinical Pharmacy)
Keywords
Pharmacist, Discharge counselling, Medication knowledge, Medication adherence