Abstract
Objective To assess the feasibility of providing a pharmacist-led pharmaceutical care service to patients with tuberculosis and diabetes mellitus. Setting The study was conducted at a tertiary hospital in the northern region of Peninsular Malaysia. Methods Action research methodology was used. Main outcome measure Pharmaceutical care issues. Results The prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 15% (53/352). Out of 53 patients identified, 35 participated in the study. Patients’ ages ranged between 29 and 73 years (mean of 52 ± 10 years). The male: female ratio was 1.7:1. Pharmaceutical care issues identified by pharmacists were nonadherence, uncontrolled diabetes mellitus, adverse drug reactions and individual patient’s medication related problems. Pharmacists were able to intervene and resolve some of the pharmaceutical care issues. Conclusion Pharmacists played an important role in integrating the provision of care for tuberculosis and diabetes mellitus by providing individualised pharmaceutical care management. There still remains a need to address logistic barriers that impinged on the ability to conduct the pharmaceutical care service to its full potential.
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References
Harries DA, Murray MB, Jeon CY, Ottmani SE, Lonnroth K, Barreto ML, et al. Defining the research agenda to reduce the joint burden of disease from Diabetes mellitus and Tuberculosis. Trop Med Int Health. 2010;15:659–63.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2,000 and projections for 2030. Diabetes Care. 2004;27:1047–53.
Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: A systematic review of 13 Observational Studies. PLoS Medicine. 2008;5:e152. doi:10.1371/journal.pmed.0050152.
Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009;9:737–46.
Wang CS, Yang CJ, Chen HC, Chuang SH, Chong IW, Hwang JJ, et al. Impact of type 2 diabetes on manifestations and treatment outcome of pulmonary tuberculosis. Epidemiol Infect. 2009;137:203–10.
Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, et al. DM and tuberculosis: the impact of the DM epidemic on tuberculosis incidence. BMC Public Health. 2007;7:234.
Dooley KE, Tang T, Golub JE, Dorman SE, Cronin W. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg. 2009;80:634–9.
Nissapatorn V, Kuppusamy I, Jamaiah I, Fong MY, Rohela M, Khairul Annuar A. Tuberculosis in diabetes patients: A clinical perspective. Southeast Asian J Trop Med Public Health. 2005;36:213–20.
Bashar M, Alcabes P, Rom WN, Condos R. Increased incidence of multi-drug resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997. Chest. 2001;120:1514–9.
Chan JCN, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–40.
Rampal S, Rampal L, Rahmat R, Md Zain A, Yee GL, Mohamed M, et al. Variation in the prevalence, awareness, and control of diabetes in a multiethnic population: a nationwide population study in Malaysia. Asia Pac J Public Health. 2010;22:194–202.
WHO. country health information profile. [Cited 2010, Aug 4]. Available from, http://www.wpro.who.int/NR/rdonlyres/DA2B128C-C64C-45FA-B1E1-D3FF8590EC71/0/19finalMAApro09.pdf.
Odegard PS, Gray SL. Barriers to medication adherence in poorly controlled diabetes mellitus. Diabetes Educ. 2008;34:692–7.
Munro SA, Lewin SA, Smith HJ, Engel ME, Fretheim A, Volmink J. Patient adherence to tuberculosis treatment: A systematic review of qualitative research. PLoS Med. 2007;4:1230–45.
World Health Organisation. An expanded DOTS framework for effective tuberculosis contro. Int J Tuberc Lung Dis. 2002;6:378–88.
Gnanasan S, Wong KT, Mohd Ali S, Ting KN, Anderson C. Pharmacist-led medication therapy adherence clinic: exploring views of health care professionals. Int J Pharm Pract. 2010;18(Suppl 1):S24–5.
Townsend A, Hunt K, Wyke S. Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use. BMJ. 2003;327:837–40.
Tulip S, Campbell D. Evaluating pharmaceutical care in hospitals. Hosp Pharm. 2001;8:275–9.
Medical Research Coucil. A framework for development and evaluation of RCTs for complex interventions to improve health. London: MRC. 2000.
Gnanasan S, Ting KN, Wong KT, Mohd Ali S, Muttalif AR, Anderson C. Medication beliefs and concerns among patients with tuberculosis and diabetes mellitus. 16th international social pharmacy workshop. Pharm Pract (Internet). 2010;8(Suppl 1):1–136.
Gnanasan S, Wong KT, Mohd Ali S, Muttalif AR, Ting KN, Anderson C. Exploring the need for pharmaceutical care (PC) management of tuberculosis and diabetes mellitus (TBDM) in Malaysia. Abstracts of the PCNE 7th Working Conference. Pharm World Sci. 2009;31:503.
Meyer J. Qualitative research in health care. Using qualitative methods in health related action research. BMJ. 2000;320:178–81.
Hart E, Bond M. Action research for health and social care: a guide to practice: Buckingham: Open University Press. 1995.
Tanna NK. Action Research: a valuable research technique for service delivery development. Pharm World Sci. 2005;27:4–6.
Gilbert AL, Roughead EE, Beilby J, Mott K, Barratt JD. Collaborative medication management services: improving patient care. Med J Aust. 2002;177:189–92.
Tanna N, Pitkin J, Anderson C. Development of the specialist menopause pharmacist (SMP) role within a research framework. Pharm World Sci. 2005;27:61–7.
Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.
Clark PM, Karagoz T, Apikoglu-Rabus S, Vehbi IF. Effect of pharmacist-led patient education on adherence to tuberculosis treatment. Am J Health Syst Pharm. 2007;64:497–506.
Mitrzyk BM. Treatment of extensively drug-resistant tuberculosis and role of the pharmacist. Pharmacotherapy. 2008;28:1243–54.
Elliott RA, Ross-Degnan D, Adans AS, Safran DG, Soumerai SB. Strategies for coping in a complex world: Adherence behavior among older adults with chronic illness. J Gen Intern Med. 2007;22:805–10.
Struijs JN, Baan CA, Schellevis FG, Westert GP, van de Bos GA. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Serv Res. 2006;6:84. doi:10.1186/1472-6963-6-84.
Marra CA, Marra F, Cox VC, Palepu A, Fitzgerald M. Factors influencing quality of life in patients with active tuberculosis. Health Qual Life Outcomes 2004;2. 58 doi:10.1186/1477-7525-2-58.
Benson J, Britten N. Patients’ decisions about whether or not to take antihypertensive drugs: qualitative study. BMJ. 2002;325:873–6.
Gordon K, Smith F, Dhillon S. Effective chronic disease management: patients’ perspectives on education-related problems. Patient Educ Couns. 2007;65:407–15.
Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, et al. Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med. 2005;61:133–55.
Rao PV. Persons with type 2 diabetes and co-morbid active tuberculosis should be treated with insulin. Int J Diabetes Dev Ctries. 1999;19:79–86.
Kotokey RK, Bhattaharya D, Das P, Azad A, De A. Study of efficacy of DOTS in pulmonary tuberculosis patients with associated diabetes. Lung India. 2007;24:58–60.
Nathan DM. Long-term complications of diabetes mellitus. N Engl J Med. 1993;328:1676–85.
Chandran M, Chu NV, Edelman SV. Gastrointestinal disturbances in diabetes. Curr Diab Rep. 2003;3:43–8.
Javadi MR, Shalviri G, Gholami K, Salamzadeh J, Maghooli G, Mirsaeedi SM. Adverse reactions of anti-tuberculosis drugs in hospitalized patients: incidence, severity and risk factors. Pharmacoepidemiol Drug Saf. 2007;16:1104–10.
Yee D, Valiquette C, Pelletier M, Parisien I, Rocher I, Menzies D. Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. Am J Respir Crit Care Med. 2003;167:1472–7.
Piette JD, Heisler M, Wagner TH. Cost-related medication underuse: do patients with chronic illnesses tell their doctors? Arch Intern Med. 2004;164:1749–55.
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Gnanasan, S., Ting, K.N., Wong, K.T. et al. Convergence of tuberculosis and diabetes mellitus: time to individualise pharmaceutical care. Int J Clin Pharm 33, 44–52 (2011). https://doi.org/10.1007/s11096-010-9452-3
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DOI: https://doi.org/10.1007/s11096-010-9452-3