Abstract

A STUDY ON IMPACT AND OUTCOMES OF CLINICAL PHARMACIST ON ASSESSEMENT OF MEDICATION ADHERENCE, DRUG UTILIZATION PATTERN AND DRUG RELATED PROBLEMS IN TYPE-2 DIABETES MELLITUS WITH HYPERTENSION IN A TERTIARY CARE HOSPITAL

Dr. Md. Anbarul Rain*, Dr. Kishor M. R., Dr. Saraswathi C. D., Dr. Aditya V.

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Abstract

Background: Diabetes mellitus is a chronic metabolic disorder which requires long term therapy. The study highlights the critical need for effective management of diabetes with hypertension in individuals with type 2 diabetes, as adherence to anti-diabetic medication is crucial for glycemic control and overall health. Understanding and addressing these DRPs, considering problems and causes are essential to optimize treatment outcomes and reduce complications. The study aims to assess the prescribing pattern of type-2 anti-diabetic drugs and antihypertensive drugs and align them with established respective treatment guidelines, emphasizing the significance of integrated care for individuals dealing the condition diabetes with hypertension. Methods: The study involved evaluating 50 outpatient prescriptions in a tertiary care setting. Data collection was conducted by reviewing medication therapy charts of patients in the outpatient department. The collected information encompassed patient demographics, lab investigations, prescribed and administered medications, progression chart details, and utilized designed data collection forms such as informed consent forms and pharmacist patient documentation forms. Medication information from patients was gathered via questionnaires, and drug utilization and evaluation were systematically executed through various steps. Results: The present study provides a thorough analysis of drug utilization patterns, medication adherence, and drug-related problems (DRPs) among 50 patients with type 2 diabetes mellitus (T2DM) and hypertension. The demographic characteristics revealed a predominance of males (62%) and patients over 40 years of age (82%). Various anti-diabetic agents and antihypertensive drugs were prescribed, with Metformin and Amlodipine being the most prevalent. The study identified 142 DRPs, with the most common being related to patient/psychological factors (48.72%). Medication adherence assessment using the MMAS-8 questionnaire indicated that a significant proportion of patients exhibited low adherence (94%). Additionally, glycemic control was achieved in only 30% of patients. The drug utilization pattern showcased prevalent use of two-drug therapy for both T2DM and hypertension. Metformin was the most frequently prescribed anti-diabetic drug, and Amlodipine was the dominant antihypertensive drug. Fixed drug combinations were widely utilized, emphasizing the need for effective therapeutic strategies. This comprehensive study sheds light on the complex interplay of drug utilization, medication adherence, and DRPs in patients with T2DM and hypertension. Addressing these factors is vital for improving patient outcomes and optimizing treatment approaches for this population. Conclusion: The conclusions from these studies highlight the hurdles in managing medications for individuals with type 2 diabetes and hypertension. Drug-related problems (DRPs) are prevalent, encompassing challenges in drug selection, dosing, and usage often influenced by psychological factors and resistance to lifestyle changes. Pharmacists are essential in addressing these issues, but further research is crucial to optimize drug therapy outcomes. Commonly prescribed medications include oral anti-diabetic drugs like metformin and glimepiride, alongside a dominance of amlodipine in antihypertensive prescriptions. Although prescriptions mostly adhere to treatment guidelines, larger studies are needed for a more comprehensive understanding. Medication adherence poses a significant challenge, primarily due to forgetfulness and inconvenience. Interventions are necessary to improve adherence, especially given the low proportion of patients demonstrating high adherence. Despite drug therapy, many individuals struggle with uncontrolled blood glucose levels, highlighting the need for improved adherence and glycemic control strategies.

Keywords: Type-2 DM, Hypertension, DRPs, Medication adherence, Drug utilization pattern, MMAS-8.