ABSTRACT
Background@#The incidence of hypertension and its complications continue to increase in the Philippine Army due to non-adherence resulting in poor health outcomes. @*Objective@#This study implemented a Medication Counseling Program (MCP) for hypertensive soldiers, and assessed the effects of the program on knowledge of disease and treatment (Knowledge), attitude towards medication (Attitude), adherence to treatment (Adherence), and blood pressure (BP). It identified and categorized pharmacist interventions applied during the counseling sessions. The perceptions of patients and physicians on pharmacist's clinical roles were also determined. @*Methodology@#The program was implemented from March to October 2015 in a government hospital for the Philippine Army. Knowledge, attitude, adherence, and BP (converted as mean arterial pressure or MAP) were measured at baseline, 30, 60, and 90th day after initial counseling. Data for pharmacist interventions were collected from patient's documentary form. The interview was conducted to patients after their 90-day counseling period and physicians after the 8-month duration of the program. @*Results@#A total of 20 patients were enrolled in the program, but only 13 patients completed the study. Of the 62 counseling sessions conducted by the pharmacist for the 8-month period, a total of 252 pharmacist interventions were administered. Knowledge, attitude, adherence, and MAP scores improved, and 100 % of the patients achieved normal/controlled BP after the 90-day counseling period. @*Conclusion@#A pharmacist MCP intervention may improve a patient's knowledge, attitude, adherence, and BP. The program enabled the pharmacist to apply pharmacist interventions to identified drug-therapy problems of the patients and resolved these through collaboration with the physicians and cooperation of the patients.
Subject(s)
Pharmacists , Military Personnel , Pharmaceutical Services , Medication Adherence , Pharmacies , Hypertension , CounselingABSTRACT
Objectives: The Primary Care Network (PCN), comprising small private General Practitioner (GP) clinics supported by a mobile team of dedicated nursing and allied health professionals, as well as a chronic disease register (CDR), can be an alternative model for good chronic disease management. GPs in the network manage the mobile team, set common goals for each clinic and self-evaluate. In this paper we share the data and experience of the first year of the pilot PCN in Singapore. Methodology: Process indicators for diabetic patients seen from April 2011 to March 2012 (pre-PCN) and April 2012 to March 2013 were compared. McNemar test was performed. Results: There was statistically significant improvement in process indicators of yearly DRP, DFS and Urine ACR screening for diabetes in the first year post-PCN compared to baseline data. Rates of regular HbA1c and LDL-C testing, as well as smoking blood pressure and weight assessment also showed statistically significant improvement. Conclusion: The PCN has shown promise in improving quality of care for diabetes among small private GP clinics. Key challenges to the success of PCN include good clinician leadership, suitable IT support, and creating a viable business model for GPs.
ABSTRACT
CONTEXTO: A abordagem de portadores de doença renal crônica (DRC) em tratamento conservador, por meio de equipes interdisciplinares, pode melhorar a qualidade de vida desses pacientes. OBJETIVOS: Avaliar os efeitos da abordagem interdisciplinar na qualidade de vida de pacientes com DRC em tratamento conservador. MÉTODOS: Setenta e cinco pacientes, acompanhados por equipe interdisciplinar (n = 50) ou por atendimento médico tradicional (n = 25), foram avaliados no início e após um ano de acompanhamento. A qualidade de vida foi avaliada pelo Medical Outcomes Study Questionaire 36 - Item Short Form Health Survey (SF-36), e a análise de parâmetros clínicos e laboratoriais foi obtida com base nos registros dos prontuários médicos. RESULTADOS: Após 1 ano de acompanhamento, os pacientes assistidos por equipe interdisciplinar apresentaram melhora nos seguintes parâmetros do SF-36: capacidade funcional, aspectos físicos, estado geral de saúde, vitalidade e aspectos emocionais; já no grupo-controle esses parâmetros permaneceram inalterados. Além disso, pacientes do grupo interdisciplinar mostraram significativa redução do peso corporal e aumento da hemoglobina e do cálcio plasmáticos. CONCLUSÕES: A abordagem interdisciplinar contribuiu para a melhora da qualidade de vida e para o controle clínico de portadores de DRC em tratamento conservador.
BACKGROUND: Multidisciplinary team-based care (MDC) of patients with chronic kidney disease (CKD) before the beginning of the renal replacement therapy may improve their quality of life. OBJECTIVES: This study aimed to assess the impact of MDC on the quality of life patients with CKD not yet on dialysis. METHODS: Seventy five patients treated by MDC (n = 50) or by standard medical care (n = 25) were evaluated at the beginning and after one year of follow-up. Quality of life was assessed by the Medical Outcomes Study Questionnaire 36 - Item Short Form Health Survey (SF-36). Clinical and laboratory parameters were obtained from the patients' charts. RESULTS: After 1-year of follow-up, the patients in MDC improved the following dimensions of the SF-36: functional capacity, physical features, general health, vitality and mood. On the other hand, the control group did not improve any dimension in quality of life. At the end of the study, the patients followed by the MDC lost body weight and showed statistically significant increases in hemoglobin and calcium plasma levels, when compared to control group. DISCUSSION: Our results showed that, compared to the standard medical care, the MDC contributed to achieve a better quality of life and clinical control in patients with CKD not yet on dialysis.