Date of Award

Winter 1-3-2020

Document Type

Dissertation

Degree Name

PharmD

Department

Department of Pharmacy Practice

First Advisor

Dr. Raviraja V Acharya

Abstract

Background: Education and counseling creates awareness amongst RA patients regarding the nature of their disease, drugs and lifestyle. Often, early diagnosis of RA prevents permanent disability. However, this does not happen in many cases. With the intention of coping with RA related complications and promoting healthy living, this study assessed the importance of counseling interventions with the aid of patient information leaflets and digital media as an adjunct for better patient care. Objectives: To study three counseling interventions, drug utilization, disease activity and quality of life in Rheumatoid Arthritis patients. Methods: A prospective study was conducted where 30 patients were enrolled based on the inclusion and exclusion criteria of the study. The patients were randomly grouped into three categories by simple randomization using Quickcals- Graphpad software. After seeking the informed consent and providing participant information sheets, each group was given a different counseling technique with the aid of expert validated leaflets. Pre and post assessment of patient’s knowledge regarding their condition was determined by administering the same questionnaire before and after the counseling session. Each session was completed within 10-15 minutes depending upon the co-operation and comprehension exhibited. A health assessment questionnaire was also administered during and after 3 months of hospitalization to assess the functional capacity of the patients. Results: Various demographic parameters like age, sex, occupation, education, co morbidities, duration of RA, disease activity and physical disability were evaluated. Among n=30 patients, most patients fell under the age group of 51-70 years (46.7%). 3 (10%) were male and 27 (90%) were female. Out of n=30 patients,20(66.7%) patients were housewives and 9 (30%), were illiterate. The duration of RA for most of the patients were between 3-5 years. (26.7%). 2 male patients and 14 female patients tested positive for rheumatoid factor. Mean DAS28 was found to be 5.64 ± 1.65 and 17 (56.7%) patients fell under high disease activity. Mean HAQ was found to be 1.18 ± 0.87 and mean VAS score was 55.67 ± 27.50. MTX was widely prescribed (n=16, 53.3%) as monotherapy or in combination with other DMARDs followed by HCQ(n=15 50%). Among combination therapy MTX+HCQ combination was preferred over other combinations and was given in 7(23.3%) patients followed by HCQ+MTX+SSZ combination in 6(20%) patients. Group C demonstrated a greater improvement in understanding and decrease in pain scores in comparison to other groups post counseling where as Group B showed greater difference in HAQ scores. Conclusion: The study demonstrated that pharmaceutical care counseling with the aid of leaflets and SMS reminders were well received by the patients resulting in improved understanding regarding their condition as well as improvement in the pain and HAQ scores. Majority of patients fell under high disease activity and MTX was widely prescribed as monotherapy. Among combination therapy MTX+HCQ combination was preferred over other combinations.

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