Goruntla Narayana, Mallela Vijayajyothi, Nayakanti Devanna
Research Department of Pharmaceutical Sciences, Jawaharlal Nehru Technological University Anantapur, Ananthapuramu, Andhra Pradesh, India.
Department of Pharmaceutical Chemistry, Raghavendra Institute of Pharmaceutical Education and Research (RIPER), Ananthapuramu, Andhra Pradesh, India.
J Pharm Bioallied Sci. 2019 Jan-Mar;11(1):69-76. doi: 10.4103/jpbs.JPBS_211_18.
Medication nonadherence is the most common issue observed in the management of diabetes because of complex and lifelong therapy. The study aimed to assess the effect of pharmacist-directed counseling and daily text message reminder on medication adherence and clinical profile of patients with type II diabetes.
This prospective, open-labeled, randomized control trial was carried out in outpatient medical department of a secondary care referral hospital. A total of 330 patients who met study criteria were enrolled and randomized into an intervention group ( = 165), received counseling and daily messages about medication intake and control group ( = 165), and usual care by physician. Medication adherence and clinical outcomes such as glycosylated hemoglobin (HbA1C), systolic blood pressure (SBP), low-density lipoprotein (LDL) cholesterol, triglyceride (TG) levels, and body mass index (BMI) were recorded at baseline and follow-up visits. Two-sample Wilcoxon rank sum test was used to compare the mean difference of medication adherence and paired -test was used to compare clinical outcomes.
The mean age of intervention and control groups were 57.1 ± 8.55 and 58.5 ± 8.53 years, respectively. The mean difference of medication adherence from baseline to second follow-up visit was significantly more in intervention group (12.2 ± 7.1%) compared to that in control group (0.75 ± 10.2 %) with a < 0.001. From baseline to second follow-up visit, HbA1C (7.79 ± 0.67 to 6.91 ± 0.83 %), SBP (136.75 ± 20.09 to 126.23 ± 18.22 mm Hg), and LDL cholesterol (104.14 ± 26.23 to 98.29 ± 20.87 mg/dL) levels were significantly reduced in intervention group compared to that in control group with a < 0.01. No significant improvement was observed in TG (169± 33.71 to 168 65 ± 33.90 mg/dL) and BMI (27.9 ± 4.21 to 27.1 ± 3.12 Kg/m) levels from baseline to second follow-up visit.
Pharmacist-directed patient counseling combined with message reminder showed a greater effect on the improvement of medication adherence and control of glycemia, blood pressure, and lipid profile in diabetes.
由于糖尿病治疗复杂且需终身服药，药物治疗依从性不佳是糖尿病管理中最常见的问题。本研究旨在评估药剂师指导的咨询和每日短信提醒对2型糖尿病患者药物治疗依从性和临床状况的影响。
本前瞻性、开放标签、随机对照试验在一家二级护理转诊医院的门诊进行。共有330名符合研究标准的患者入组并随机分为干预组（n = 165），接受关于药物服用的咨询和每日短信提醒，以及对照组（n = 165），接受医生的常规护理。在基线和随访时记录药物治疗依从性和临床结局，如糖化血红蛋白（HbA1C）、收缩压（SBP）、低密度脂蛋白（LDL）胆固醇、甘油三酯（TG）水平和体重指数（BMI）。采用两样本Wilcoxon秩和检验比较药物治疗依从性的平均差异，采用配对t检验比较临床结局。
干预组和对照组的平均年龄分别为57.1±8.55岁和58.5±8.53岁。从基线到第二次随访，干预组的药物治疗依从性平均差异（12.2±7.1%）显著高于对照组（0.75±10.2%），P<0.001。从基线到第二次随访，干预组的HbA1C（7.79±0.67%至6.91±0.83%）、SBP（136.75±20.09至126.23±18.22mmHg）和LDL胆固醇（104.14±26.23至98.29±20.87mg/dL）水平显著低于对照组，P<0.01。从基线到第二次随访，TG（169±33.71至168.65±33.90mg/dL）和BMI（27.9±4.21至27.1±3.12Kg/m²）水平未观察到显著改善。
药剂师指导的患者咨询结合短信提醒对改善糖尿病患者的药物治疗依从性以及控制血糖、血压和血脂水平有更大效果。
