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Impact of hospital pharmacist-delivered individualised pharmaceutical service intervention on clinical and patient-reported outcomes in patients with hypertension: a randomised controlled trial
  1. Nabina Paudel1,
  2. Shakti Shrestha2,3,
  3. Nirmal Raj Marasine4,
  4. Pitambar Khanal5,
  5. Sushant Aryal6,
  6. Daniel Erku7,8,
  7. Arjun Poudel3,9
  1. 1School of Pharmacy, Kathmandu University, Dhulikhel, Nepal
  2. 2School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
  3. 3Quality Use of Medicine Research Network Nepal, Chitwan, Nepal
  4. 4Department of Pharmacy, Karnali College of Health Sciences, Kathmandu, Nepal
  5. 5Department of Pharmacy, Nepalgunj Medical College, Nepalgunj, Nepal
  6. 6School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
  7. 7Centre for Applied Health Economics, Griffith University, Nathan, Queensland, Australia
  8. 8Menzies Health Institute Queensland, Griffith University, Goldcoast, Queensland, Australia
  9. 9School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
  1. Correspondence to Shakti Shrestha, School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia; shakti.shrestha{at}uq.edu.au

Abstract

Objectives Patients with hypertension in Nepal are often known to have poor medication adherence and quality of life. This randomised controlled trial aimed to evaluate the impact of a hospital pharmacist-delivered individualised pharmaceutical service (P-DIPS) intervention on blood pressure, medication adherence and health-related quality of life (HRQoL) among patients with hypertension in a hospital setting in Nepal.

Methods In an open trial, 56 adult patients with hypertension who had been receiving antihypertensive medication for ≥6 months were randomly allocated to a control group (n=28) which received the usual care and an intervention group (n=28) which received a P-DIPS along with the usual care. The difference in blood pressure, medication adherence and HRQoL between the two groups at baseline, 2 and 4 months was compared using the Mann–Whitney U test, independent t-test or χ2 tests.

Results Participants were mostly ≥40 years (86%) and female (57%). There were no significant differences in the baseline characteristics between the control (C) and intervention (I) groups. At 2 months, the two groups had a significant improvement in the median (IQR) Morisky–Green–Levine (MGL) Medication Adherence Score (I=1 (2) vs C=2 (2); p<0.001) and the median (IQR) mental component of HRQoL (I=43.6 (9.5) vs C=37.5 (8.6); p=0.013). At 4 months, there were significant differences in the median (IQR) values of all the outcome measures between the groups (systolic blood pressure: I=125 (10) mmHg vs C=130 (15) mmHg, p=0.008; diastolic blood pressure: 80 (14) mmHg vs 90 (10) mmHg, p=0.012; MGL score: I=1 (1) vs C=2 (1), p<0.001; physical component of HRQoL: 45.0 (9.0) vs 40.3 (8.2), p=0.046; and mental component of HRQoL: 47.1 (11.1) vs 38.8 (8.5), p=0.003).

Conclusions The findings suggest that a P-DIPS intervention in the hospital setting of Nepal has a significant potential to improve blood pressure, medication adherence and HRQoL in patients with hypertension.

  • pharmacy service
  • hospital
  • randomized controlled trial
  • hypertension
  • health services administration
  • primary health care
  • communicable diseases

Data availability statement

Data are available upon reasonable request.

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