Proactive pharmaceutical care and treatment outcome in psychiatric patients: A retrospective quasi-experimental study
Keywords:
Proactive pharmaceutical care, Drug related problems, Pharmacist, Psychiatric disorders, Treatment outcomeAbstract
This retrospective quasi-experimental study aims to evaluate the effectiveness of proactive pharmaceutical care by pharmacists and examine the characteristics of drug-related problems among psychiatric patients. The study included psychiatric patients who were followed up at the psychiatric clinic of Chiang Kham Hospital. The experimental group received proactive pharmaceutical care from October 1, 2022, to May 31, 2023. The historical control group received standard pharmaceutical care from October 1, 2021, to September 30, 2022. Proactive pharmaceutical care involved pharmacists identifying and resolving drug-related problems and monitoring adverse drug reactions. Treatment effectiveness was assessed 3 months post-consultation using the adapted clinical global impression-improvement (CGI-I) scale with four levels: 1. No improvement or death, 2. Partial improvement, 3. Improvement, and 4. Stable condition. Associations between pharmaceutical care and treatment outcomes were analyzed using ordered logistic regression, adjusted for gender, age, and psychiatric diagnosis, with results presented as common odds ratio (COR) with 95% confidence intervals (CIs). A total of 192 patients were included: 35 in the proactive pharmaceutical care group and 157 in the historical control group. Of these, 54.2% were male, with a mean age of 48.98 ± 15.83 years. Diagnoses included schizophrenia (55.7% of all participants), depression and anxiety (28.6% of all participants), and other psychiatric disorders (15.6% of all participants). Of 230 identified drug-related problems, the most common problems were lack of monitoring for adverse drug reactions (46.5% of all drug-related problems), occurrence of adverse drug reactions (16.5% of all drug-related problems), and patients not receiving prescribed medications (16.1% of all drug-related problems). Interestingly, the proactive care group showed better treatment outcomes, with an adjusted COR of 3.12 (95% CI: 1.41, 6.91). This association was more pronounced in females (adjusted COR: 3.60; 95% CI: 1.15, 11.28) than in males (adjusted COR: 3.09; 95% CI: 0.94, 10.17). Sensitivity analyses confirmed these findings. In conclusion, this study highlights that adverse drug reactions are significant drug-related problems in psychiatric patients. Proactive pharmaceutical care by pharmacists is associated with improved treatment outcomes in psychiatric outpatients. Further research in other hospital settings is recommended to confirm these findings, which could lead to enhanced quality of care for psychiatric patients.
References
Department of Mental Health’s annual report 2018 [Internet]. 2018 [cited 2024 Jul 28]. Available from: https://dmh-elibrary.org/items/show/188.
Samprasit N, Thavornwattanayong W. Outcome of pharmaceutical care in patients with psychiatric disorder: a systematic review. JHSR. 2018;12(4):590–607.
Anekwit N. Relapse rate of schizophrenia and other psychotic disorders in patients at Mahasarakham hospital. J DMS. 2018;43(5):35-9.
Kaeokumbong C, Chaiyakum A. Effectiveness of pharmaceutical care at schizophrenia clinic in psychiatric hospital. Isan J Pharm Sci. 2015;11(1):159–67.
Kanjanasilp J, Juthamanee D, Lelatanaruk A. The effects of pharmaceutical care in schizophrenia patients with caregivers education. Journal of Nakhon Ratchasima Rajanagarindra Psychiatric Hospital. 2011;11(1):40–50.
Busner J, Targum SD. The Clinical Global Impressions Scale: applying a research tool in clinical practice. Psychiatry (Edgmont). 2007;4(7):28–37.
Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use. 5th ed. Oxford: Oxford University Press; 2015.
Department of Mental Health, Ministry of Public Health. Clinical practice guideline of major depressive disorder for general practitioner [Internet]. 2010 [cited 2024 Dec 25]. Available from: https://www.thaidepression.com/www/news54/CPG-MDD-GP.pdf.
Lotrakul M. Psychiatric drug handbook. 2nd ed. Bangkok: Moh Chao Ban, 2004.
Cipolle R, Strand L, Morley P. Pharmaceutical care practice: the patient centered approach to medication management. 3rd ed. New York: McGraw-Hill; 2012.
Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24(11):1093–7.
Kitpaiboontawee S. Pharmaceutical care in general medical ward at middle-level Hospital. Reg11med. 2017;31(3):369–83.
Pharmaceutical Care Network Europe Association. PCNE classification for drug related problems V9.1 [Internet]. 2020 [cited 2024 Dec 25]. Available from: https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf.
Bender R, Crouven U. Ordinal logistic regression in medical research. J R Coll Physicians Lond. 1997;31(5):546–51.
Samprasit N, Bunchuailua W, Kapol N. Outcomes of pharmacist intervention in schizophrenic patients: a systematic review and meta-analysis of randomized controlled trials. Srinagarind Med J. 2020;35(5):576–83.
Renaudin P, Boyer L, Esteve MA, Bertault-Peres P, Auquier P, Honore S. Do pharmacist-led medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(6):1660–73.
US Food and Drug Administration. Full prescribing information of Seroquel [Internet]. 2020 [cited 2024 Jul 28]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/020639s072lbl.pdf.
National Drug Information. Antipsychotic drugs in national essential drug list and evidence-based [Internet]. 2016 [cited 2024 Jul 28]. Available from: https://ndi.fda.moph.go.th/drug_national_detail/index/11912.
Akarakunanon S. Major adverse effects of clozapine. Poisson & Drug Information Bulletin. 2010;18(1):9–12.
Chuangsakul N. Effects of pharmaceutical care in patients using lithium, psychiatric clinic, Sisaket Hospital. MJSBH. 2021;36(3):555–62.
Moskovitz C, Moses H, Klawans HL. Levodopa-induced psychosis: a kindling phenomenon. Am J Psychiatry. 1978;135(6):669–75.
Mahal P, Nishanth KN, Mahapatra A, Sarkar S, Balhara YPS. Trihexyphenidyl misuse in delusional disorder. J Neurosci Rural Pract. 2018;09(03):428–30.
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez A V., et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456–73.
Suanchang O, Kulsomboon V, Sirisinsuk Y, Phoomchan N, Skawatananont C. Clinical outcomes of a pharmaceutical care service in lithium clinic adjunct to standard care compared with standard care alone in patients with bipolar disorder: 10 years naturalistic retrospective cohort study. TJPS. 2017;41(4):166-73.
Sathienluckana T, Unaharassamee W, Suthisisang C, Suanchang O, Suansanae T. Anticholinergic discontinuation and cognitive functions in patients with schizophrenia: a pharmacist-physician collaboration in the outpatient department. Integr Pharm Res Pract. 2018;7:161-71.
Wiriyasirisakul T, sariyachaikul T, Kanjanasilp J, Suttiruksa S. Outcomes of pharmaceutical care in outpatients with schizophrenia: a randomized controlled trial. Thai J Pharm Prac. 2016;8(2):377-87.
Kanjanasilp J, Ploylearmsang C. A short term outcomes of pharmaceutical care in Thai patients with schizophrenia: a randomized controlled trial. SJST. 2016;38(2):189-97.
Kenkratoke J, Kanjanasilp J, Leelathanaroek A, Dudsadeeprasert J. Effect of pharmaceutical care in patients with schizophrenia and drug counseling for caregivers at Nakhon Ratchasima Rajanagarindra Psychiatric Hospital. Journal of Nakhon Ratchasima Rajanagrindra Psychiatric Hospital. 2010-2011;11(1):40-50.
Kenkratoke J. Pharmaceutical care in patients with schizophrenia and drug counseling for caregivers at Nakon Ratchasima Rajanagarindra Psychiatric Hospital [dissertation]. Mahasarakham: Mahasarakham university; 2011.
Chummuangpak P. Cost-effectiveness of pharmaceutical care in schizophrenia out patients: a study in Prasrimahabhodi Psychiatric hospital. Ubonratchathani [dissertation]. Mahasarakham: Mahasarakham university; 2010.
Rat-anan P. Outcome of pharmaceutical care in schizophrenia outpatients at Nakonratchasima Rajanagarindra Psychiatric Hospital [dissertation]. Mahasarakham: Mahasarakham university; 2010.
Biau DJ, Kernéis S, Porcher R. Statistics in brief: the importance of sample size in the planning and interpretation of medical research. Clin Orthop Relat Res. 2008;466(9):2282–8.
Goodman SN. The use of predicted confidence intervals when planning experiments and the misuse of power when interpreting results. Ann Intern Med. 1994;121(3):200.
Jaroenphol P, Sangon S, Nintachan P. Selected factors related to medication adherence in persons with schizophrenia. JPNMH. 2019;33(2):29–46.
Pimwan T, Natprayut N. Factors associated with caregiver burden of schizophrenia patients. J Psychiatr Assoc Thailand. 2021;33(2):203–16.
Namlao W, Nabkasorn C, Vatanasin D. Factors affecting burden among caregivers of patients with schizophrenia in Sakaeo Rajanagarindra Psychiatric Hospital. JPNC. 2018;29(2):24–35.
Mata C, Inpan C, Chaiprom P, Promchat P, Rattanathanakorn A. Factors influencing depression among working-age population: a case study of community in Ngao district, Lampang province. NJPH. 2022;32(3):187–97.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 University of Phayao
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
ผู้นิพนธ์ต้องรับผิดชอบข้อความในบทนิพนธ์ของตน มหาวิทยาลัยพะเยาไม่จำเป็นต้องเห็นด้วยกับบทความที่ตีพิมพ์เสมอไป ผู้สนใจสามารถคัดลอก และนำไปใช้ได้ แต่จะต้องขออนุมัติเจ้าของ และได้รับการอนุมัติเป็นลายลักษณ์อักษรก่อน พร้อมกับมีการอ้างอิงและกล่าวคำขอบคุณให้ถูกต้องด้วย
The authors are themselves responsible for their contents. Signed articles may not always reflect the opinion of University of Phayao. The articles can be reproduced and reprinted, provided that permission is given by the authors and acknowledgement must be given.
