Measure of pharmacists role in the management and adherence of HIV infected patients in a public sector hospital of KwaZulu-Natal.
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Date
2011
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Abstract
Background:-
The HIV and AIDS epidemic is a major catastrophe that affects millions of people
worldwide. Antiretroviral medication combinations have revolutionised HIV
treatment since 1996, transforming the virus from a death sentence to a manageable
condition. In order to obtain full therapeutic benefits it is vitally important that
patients adhere to their prescribed medication. Being informed about the disease and
medication contributes to patient adherence and management.
Pharmacists are considered to be the most accessible health professional and can help
HIV -infected patients deal with barriers to medication access, manage adverse effects
and medication interactions, and adhere to medication regimens by appropriate
counselling. The public sector is defined as that part of an economy that is controlled
by the state. At the study site, which is a public sector facility, the roll out of
antiretroviral medication started in 2006. At the time all patients were counselled by
trained counsellors, before seeing a doctor. At the pharmacy the medication was
collected with no intense counselling by a pharmacist as the patients would have
visited the trained counsellors first.
Subsequently it was found that there were many queries regarding HIV and AIDS. It
was then decided in October 2007, that the pharmacist support the counselling done
by the counsellors in that they should reinforce what was said by the counsellors,
together with giving detailed information to patients on their health and medication.
This study was therefore undertaken to measure pharmacists' role in the
management and adherence of HIV infected patients at this institutional facility.
Method:
The study was undertaken at a public sector health facility using anonymous
structured questionnaires and was divided into 3 phases: Pre-Intervention,
Intervention and Post-Intervention phases. After obtaining patient consent the
questionnaires were administered during the 1st phase. A month later all patients
visiting the pharmacy were counselled intensely on various aspects of HIV and the
antiretroviral medication. Thereafter patients who took part in phase 1 were asked to
participate in the 2nd phase. After obtaining their consent again, the same
questionnaire was administered to them. Quantitative variables were compared
between pre and post intervention using paired t-tests or Wilcoxon signed ranks tests.
Categorical variables were compared using McNemar's chi square test (Binary) or
McNemar-Bowker test for ordinal variables.
Results:
A response rate of 87.5% was obtained with the majority of the patients being female.
Almost 70% of the participants were in the age-range of 21-40 years old. The majority
of the participants did not have post school education.
Most of the participants (95.4%) did not know that HIV is a virus that causes AIDS in
the pre intervention phase, but this decreased to 93.7% in the post intervention phase.
The participants knowledge of people who have sexually transmitted diseases are least
at risk of getting HIV, healthy food will cure HIV and smoking and drinking alcohol
will weaken the HIV virus, increased significantly from the pre-intervention phase to
the post intervention phase. Knowledge on the modes of transmission either increased
or remained unchanged.
Overall the mean knowledge score on the disease itself had increased significantly
(SD 6.6%) [p<0.01] after the pharmacists' intervention (pre-intervention was 82.1 %,
post-intervention was 86.3%). In both phases, over 40% of all patients stored their
medication in the cupboard. The majority of the patients took their medication either
with or without food at both phases of the study. After the intervention, the frequency
of taking medication with a fatty meal or any time they remember was decreased to 0.
A significant improvement was noted in the overall knowledge score with regards to
medication taking and storage (p<0.05).
Conclusion:
Pharmacist intervention had a positive impact on HIV infected patients' HIV and
AIDS knowledge on the disease and on the antiretroviral medication use and storage.
Description
Thesis (M.Pharm.)-University of KwaZulu-Natal, Durban, 2011.
Keywords
HIV infections--KwaZulu-Natal., Pharmacists--KwaZulu-Natal., HIV-positive persons--Care--KwaZulu-Natal., Theses--Pharmacy and pharmacology.