Assessment of Prescription Pattern, Follow-Up Pattern and Impact of Pharmacist Initiated Educational Intervention on Medication Adherence in Patients with Psychiatric Disorders

Abstract

Background: To conduct a prospective observational study on prescribing pattern, follow-up pattern and impact of pharmacist initiated educational intervention on medication adherence in patient with psychiatric disorder. Aim And Objectives: The aim of this study is to evaluate the impact of clinical pharmacist interventions in the psychiatric setting in patient with psychiatric disorders. To find out the prescription pattern and follow up pattern of anti-psychotic medication in department of psychiatry. To identify the drug related problems of anti-psychotic medication in psychiatric patients. To improve the medication adherence of psychiatric patients. Methods: A Prospective interventional study of 6 months was conducted. Undertaken 102 patients’ data collection form of all the patient of outpatient department of age 18 ? years of psychiatric disorder with or without co-morbidity. Results: The results of this analysis suggest that out of the total 102 psychiatric patient included in the study 59 patient were males while 43 patients were females. Out of the total study subject, among the 102 psychiatric patients, patient with psychosis were found to be 40(39.21%), followed by insomnia 14(13.72%), schizophrenia 13(12.74%), anxiety disorder 12(11.76%), bipolar disorder 7(6.86%), anger disorder 5(4.90%), depression 5(4.90%), and with other psychiatric disorder were 6(5.88%). Conclusion: This study concludes that psychiatric disorder was more seen in male patient compared to female patients most of them were in the age of 31-45 years constituting of 37.25% of total patients during the study it is observed that Risperidone was the most commonly prescribed Anti-psychotic drug and it was mostly prescribed with Trihexyphenidyl.

Keywords

Introduction

TABLE 1. DEPICTING THE AGE WISE DISTRIBUTION OF PATIENTS

SR. NO	AGE GROUP	NUMBER OF PATIENTS	PERCENTAGE
01	18-30	37	36.27%
02	31-45	38	37.25%
03	46-60	22	21.56%
04	61-75	5	04.92%
	TOTAL	102	100%

TABLE 2. DEPICTING THE GENDER WISE DISTRIBUTION OF PATIENTS

TABLE 3. DEPICTING THE DISEASE WISE DISTRIBUTION OF PATIENTS

FIGURE4. GRAPH REPRESENTING THE REGION WISE DISTRIBUTION OF PATIENTS

SR. NO	QUESTIONS	RESPONSE
		PRE		POST
		YES	NO	YES	NO
1	Do you sometimes forget to take your Psychotropic medicine?	93%	7%	69%	31%
2	Over the past two weeks, were there any days when you did not take your Psychotropic medicine?	91%	9%	77%	23%
3	Have you ever cut back or stopped taking your medication without telling your doctor, because you felt worse when you took it?	63%	37%	68%	32%
4	When you travel or leave home, do you sometimes forget to bring along your medications?	50%	50%	26%	74%
5	“Did you take your Psychotropic medicine yesterday?”	84%	16%	88%	12%
6	When you feel like your Psychotic symptoms are under control, do you sometimes stop taking your medicine?	24%	76%	31%	69%
7	Taking medication everyday is a real inconvenience for some people. Do you ever feel hassled about sticking to your plan?	24%	76%	18%	82%
8	How often do you have difficulty remembering to take all your Psychotropic medicine	90%	10%	48%	52%

DISCUSSION

• In the present study a total of 102 patients were enrolled comprising of 59(57.85%) were Males and 43(42.15%) were Females, which was lower than the study conducted by Mudhaliar M R et al, comprising of 91(60.67%) were males and 59(39.33%) were females.
• In our study we found that majority of patients were between the age group of 31 - 45(37.25%) followed by the age group 18 - 30(36.27%), 46 - 60(21.56%) and the age group of 61 - 75(4.92%).
• In the total of 102 study subjects, the number of patients diagnosed with Psychosis were 40(39.21%), Insomnia 14(13.72%), Schizophrenia 13(12.74%), Anxiety disorder 12(11.76%), Bipolar disorder 7(6.86%), Anger disorder 5(4.9%), Depression 5(4.9%) and Patient’s with other disorders were found to be 6(5.88%).
• The most commonly prescribed medication among various Psychotropic medications were from the drug class Antipsychotic drugs, among which T RSPN was most commonly prescribed and it was given in the dose of 2mg.
• Among the 102 total test subjects 47(46.07%) came for the follow up for their treatment. Which was similar to the study conducted by Ramamurthy P, et al, which had a follow up rate of 56.36%
• In our study we observed that 82.6% of the prescription consisted of 2-3 drugs. These findings suggested a rise in the incidence of polypharmacy which is supported by the study conducted Deshmukh and Ismail.
• For our study we used MORSIKY MEDICATION ADHERENCE SCALE (MMAS-8) which is a GOLD STANDARD to assess medication adherence among psychiatric patients by interviewing them through self modified MMAS-8 questionaries.

CONCLUSION

This study concludes that psychiatric disorders were more seen in male patients compared to female patients. Most of the study subjects were from the age group of 31- 45years constituting of 37.25% of total patients. During the study it is observed that Tab RSPN was most commonly prescribed anti-psychotic drug and it was mostly prescribed with Tab THP.

Tab Risperidone, Tab Trihexyphenidyl, Tab Olanzapine, Tab Fluoxetine are most commonly prescribed psychotropic drugs. Most patients were prescribed 2-3 psychotropic medications which included Tab Risperidone, Tab Trihexyphenidyl, Tab Fluoxetine, however polypharmacy must be minimized in psychiatric out patients as it might results in poor compliance, increased drug interactions and side effects. Our study was carried out for a period of 6 months and was mainly confined to Psychiatry Out Patient Department (OPD) in GIMS Hospital. Were we found out that the follow up rate and medication adherence were poor. This study provide baseline for conduct of drug utilization studies periodically for a longer duration over large population size and provide benefits to psychotic patients in near future.

ACKNOWLEDGEMENT

The authors express their gratitude to Dr. ASHOK KUMAR MALPANI, Professor & Principal, RMES’s College of Pharmacy, Kalaburagi for the encouragement and significant support received throughout the research.

AUTHOR’S CONTRIBUTION

All the authors have contributed equally.

CONFLICT OF INTEREST

All authors declare that there are no conflicts of interest.

ETHICS DECLARATION

The Institutional Ethics Committee at RMES’s College of Pharmacy approved the protocol. All residents in the hospital provided informed consent.

CONSENT FOR PUBLICATION

All authors have consented to the publication of their work.

COMPETING INTERESTS

The authors hereby declare that they did not obtain any financial support from any source for the writing or publication of this article

AUTHORS FUNDING

The authors hereby declare that they did not obtain any financial support from any source for the writing or publication of this article.  

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