Outcomes of Pharmaceutical Care in Non-adherent Patients with Pulmonary Tuberculosis in Intensive Phase of Treatment

Abstract

Objectives: To compare the outcomes before and after the provision of pharmaceutical care in non-adherent patients with pulmonary tuberculosis during intensive phase of treatment. Method: This quasi-experimental study in non-adherent patients with pulmonary tuberculosis during intensive phase of treatment was conducted in Banphai Hospital, Khon Kaen during June 2021 to February 2022. Patients with medication non-adherence identified using pill counting at 14 days after start of the drug were invited to participate in the study. The intervention included three regular pharmaceutical care services in the hospital 3 times on days 14, 28 and 56 after initiation of medication and one home visit by pharmacists on day 21 after initiation of medication. Activities during home visits included evaluation with the INHOMESS tool, giving instruction on DOT (direct observe treatment) to caregivers, identifying and resolving DRPs, and providing drug knowledge to patients and caregivers. Results: Among 117 pulmonary tuberculosis patients after 14 days of drug treatment, 40 (34.19%) were non-adherent and all were invited to participate in the study. At days 28 and 56 after the intervention, 2 and 1 were non-adherent, respectively. During home visits on day 21 after the start of drug use, 11 DRPs in 11 patients were identified.  The most common problem was inappropriate drug selection (5 times) such as patients self-medicating with herbal tea, traditional medicines for pain killers, capsules obtained from groceries, tea from cannabis leaves. The problems were most resolved at the patients (7 out of 11 problems) by modifying their attitudes toward treatment. Mean scores of knowledge on the disease, self-care behavior and medication use before day 14 and after home visit on day 28 were 9.68 ± 2.17 and 13.05 ± 1.20, respectively (P<0.001).At the end of intensive phase of treatment, sputum examination and lung x-rays showed 2 cases of positive sputum and 3 cases of lung lesions. The number of family members helping in supervising drug taking increased from 22 before pharmaceutical care provision to 35 after pharmaceutical care provision. Conclusion: Usual pharmaceutical care together with home visits was effective in enhancing anti-TB drug adherence in the intensive phase of treatment.