Effect of a Pharmacist Intervention on Self Management Practices Among Hypertensive-Diabetic Patients Receiving Care in a Nigerian Tertiary Hospital

Abstract

Objective: The objective of this study was to evaluate the effect of a pharmacist-led intervention on self-management practices among hypertensive-diabetic patients receiving care in a Nigeria tertiary hospital.
 Methods: The study adopted a prospective, longitudinal; single-blind, two-arm randomised controlled trial to implement a pharmacist-led educational intervention on hypertension management among patients in Federal Medical Centre Lokoja, Kogi State. All the patients who met the eligibility criteria and gave their written consent to participate in the study were recruited into the study randomized in the intervention group (IG) and Control (CG). Data was collected using Hypertension Self Care Activity Level Effects (H-SCALE) questionnaire. The retrieved questionnaires were first coded into Microsoft Excel (2014) for cleaning of errors, after which the data was exported into the Statistical Product and Services Solutions (SPSS for windows, Version 16.0. SPSS Inc. 2007, Chicago, USA) software. Descriptive statistics such as frequencies, percentages and mean scores were used to summarise the data. All responses were first presented as frequencies and percentages. Chi-square was used to determine the correlation between socio-demographic and patients’ clinical characteristics. Independent sample t-test and paired sample t-test were used to compare differences between and within groups.
 Results: At baseline, more patients in the control group were adherent to their medications 16 (11.5) and had low salt diets 47 (33.8) than patients in the intervention group. However, more patients in the intervention group were non-smokers 127 (88.8) and engaged more in physical activity 38 (26.6) than patients in the control group. However, more of the patients in the control group were adherent to weight management practices 38 (27.3) than patients in the intervention group 36 (25.2), at baseline. All the patients in both study groups reported to have taken alcohol in the past seven days. It can be seen that, patients in the intervention group at endpoint, differed positively from the control group at baseline in adherence to medication, physical activity, reducing alcohol consumption and smoking cessation. It can also be observed that the baseline intervention group differed positively from the endpoint in medication adherence (t=-26.045, p<0.001); physical activity (t=-15.081, p<0.001); weight management practices (t=-5.479, p<0.0010, and alcohol consumption 9t=-11.550, p<0.001).
 Conclusion: A pharmacist led educational intervention had a positive impact on the self-management practices of hypertensive-diabetes patients.

Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review

“…Our initial search identified 3,968 studies of which 33 studies conducted in 10 African countries: South Africa ( n = 10; 30.3%) [ 26 – 35 ], Nigeria ( n = 7; 21.2%) [ 36 – 42 ], Ghana ( n = 4; 12.1%) [ 43 – 46 ], Kenya ( n = 4; 12.1%) [ 47 – 50 ], Cameroon ( n = 3; 9.1%) [ 51 – 53 ], Democratic Republic of Congo ( n = 1; 3.0%) [ 54 ], Ethiopia ( n = 1; 3.0%) [ 55 ], Malawi ( n = 1; 3.0%) [ 56 ], Rwanda ( n = 1; 3.0%) [ 57 ], and Uganda ( n = 1; 3.0%) [ 58 ], were deemed eligible for inclusion (Table 1 and Fig. 2 ).…”

“…More studies were conducted in both rural and urban areas ( n = 13; 39.4%) than in urban areas only ( n = 12; 36.4%) or rural areas only ( n = 8; 24.2%). RCTs were the least employed study design included ( n = 6; 18.2%)[ 29 , 31 , 33 , 37 , 42 , 43 ] with half of these conducted in South Africa ( n = 3; 50.0%). The disease of focus for included studies was hypertension only ( n = 16; 48.5%) [ 26 , 33 , 36 – 39 , 41 , 43 , 45 , 46 , 49 , 50 , 52 , 54 , 57 , 58 ], diabetes mellitus only ( n = 5; 15.2%) [ 27 – 30 , 55 ], acute kidney injury ( n = 1; 3.0%) [ 56 ], and multiple NCD risk factors ( n = 11; 33.3%) [ 31 , 32 , 34 , 35 , 40 , 42 , 44 , 47 , 48 , 51 , 53 ].…”

“…The disease of focus for included studies was hypertension only ( n = 16; 48.5%) [ 26 , 33 , 36 – 39 , 41 , 43 , 45 , 46 , 49 , 50 , 52 , 54 , 57 , 58 ], diabetes mellitus only ( n = 5; 15.2%) [ 27 – 30 , 55 ], acute kidney injury ( n = 1; 3.0%) [ 56 ], and multiple NCD risk factors ( n = 11; 33.3%) [ 31 , 32 , 34 , 35 , 40 , 42 , 44 , 47 , 48 , 51 , 53 ].…”

“…Overall, tasks were mostly shifted to nurses ( n = 19; 57.6%) [ 26 – 28 , 30 , 31 , 35 , 37 , 39 , 43 , 45 – 47 , 50 – 52 , 54 – 57 ], and this was true for studies from South Africa, Ghana, Cameroon, Democratic Republic of Congo (DRC), Ethiopia, Malawi and Rwanda. However, in four out of the seven studies from Nigeria, more tasks were shifted to pharmacists[ 36 , 38 , 40 , 42 ] (Supplementary Table S 2 ). Several studies reported multiple roles for tasks to be shifted and the roles included treatment and adherence support ( n = 28; 84.9%) [ 26 – 37 , 39 , 41 , 42 , 44 – 47 , 49 , 51 – 57 ], disease screening and detection ( n = 24; 72.7%) [ 26 , 27 , 30 – 32 , 34 , 35 , 37 , 38 , 40 , 41 , 44 – 46 , 48 – 53 , 55 – 58 ], education and counselling ( n = 24; 72.7%) [ 26 – 30 , 32 – 34 , 36 – 39 , 41 – 46 , 51 – 53 , 55 – 57 ], and triage ( n = 13; 39.4%) [ 26 , 30 , 32 –…”

“…However, in four out of the seven studies from Nigeria, more tasks were shifted to pharmacists[ 36 , 38 , 40 , 42 ] (Supplementary Table S 2 ). Several studies reported multiple roles for tasks to be shifted and the roles included treatment and adherence support ( n = 28; 84.9%) [ 26 – 37 , 39 , 41 , 42 , 44 – 47 , 49 , 51 – 57 ], disease screening and detection ( n = 24; 72.7%) [ 26 , 27 , 30 – 32 , 34 , 35 , 37 , 38 , 40 , 41 , 44 – 46 , 48 – 53 , 55 – 58 ], education and counselling ( n = 24; 72.7%) [ 26 – 30 , 32 – 34 , 36 – 39 , 41 – 46 , 51 – 53 , 55 – 57 ], and triage ( n = 13; 39.4%) [ 26 , 30 , 32 – 34 , 40 , 41 , 44 , 47 – 49 , 58 ]. In each category of task shifted roles examined, studies from South Africa had the highest proportions (Supplementary Table S 2 ).…”