Impact of pharmacist educational intervention on disease knowledge, rehabilitation and medication adherence, treatment-induced direct cost, health-related quality of life and satisfaction in patients with rheumatoid arthritis: study protocol for a randomized controlled trial

Abstract

Background: The objective of this study is to evaluate the effectiveness of pharmacist intervention in improving disease knowledge, adherence to treatment, health-related quality of life (HRQoL) and direct cost of treatment. The study also documents patient satisfaction with pharmacist counselling as a quality control measure. Methods/design: This is a randomized, single-blind, two-arm, controlled trial in patients with rheumatoid arthritis visiting outpatient rheumatology clinics in Karachi, Pakistan. We will enroll patients with established diagnosis of rheumatoid arthritis over 3 months. The patients would be randomized through a computer-generated list into the control group, i.e., usual care or into the intervention group, i.e., pharmaceutical care, in a ratio of 1:1, after providing signed written consent. The study will take place in two patient-visits over the course of 3 months. Patients in the intervention group would receive intervention from the pharmacist while those in the control group will receive usual care. Primary outcomes include change in mean score from baseline (week 0) and at follow up (week 12) in disease knowledge, adherence to medications and rehabilitation/physical therapy. The secondary outcomes include change in the mean direct cost of treatment, HRQoL and patient satisfaction with pharmacist counselling. Discussion: This is a novel study that evaluates the role of the pharmacist in improving treatment outcomes in patients with rheumatoid arthritis. The results of this trial could set the foundation for future delivery of care for this patient population in Pakistan. The results of this trial would be published in a peer-reviewed journal.

Estimation of direct cost of managing rheumatoid arthritis treatment to Pakistani patients using real‐world follow‐up data

“…Pakistani women have a higher incidence of RA. The YLDs are estimated to be over 40 years while DALYs of 50 or more are reported . This proportion for Pakistani women with RA was consistent with findings of Kawatkar and colleagues who reported more than 60% women in a RA patient cohort in the USA .…”

“…The YLDs are estimated to be over 40 years while DALYs of 50 or more are reported. 1,4 This proportion for Pakistani women with RA was consistent with findings of Kawatkar and colleagues who reported more than 60% women in a RA patient cohort in the USA. 23 Most patients mentioned that they were graduates, that is, had at least 16 years or education, as well as, were either employed or associated with household activities.…”

“…Although its prevalence in Pakistan is not as high as other endocrine and cardiovascular diseases, the figures for disease-adjusted life years (DALYs) and years lived with disability (YLDs) are quite high in this population. 1,4 The mean age of patients in our study was 48 years. This was in line with findings of a systematic review that the mean age of patients who presented with RA in Pakistani settings was 44 years.…”

“…RA is one of those diseases that result in disability. Although its prevalence in Pakistan is not as high as other endocrine and cardiovascular diseases, the figures for disease‐adjusted life years (DALYs) and years lived with disability (YLDs) are quite high in this population …”

“…The disease predominantly affects joints that result in difficulty in mobilization and locomotion . Gradually it deforms the joints resulting in joint stiffness, pain, inflammation and diminished joint movement . The disease is known to affect work ability and studies report that many patients with RA retire from work early.…”