A study on impact of clinical pharmacist intervention on knowledge, at

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 349 IJAMSCR |Volume 3 | Issue 3 | July-Sep- 2015 www.ijamscr.com Research article Medical research A study on impact of clinical pharmacist intervention on knowledge attitude and practice of patients with diabetes in a tertiary care teaching hospital Mahesh Kumar S Praveen Kumar M Shiva Krishna G Amulya P Navaneetha K Nagireddy G Smt. Sarojini Ramulamma College of Pharmacy Sheshadrinagar Mahabubnagar Telangana India Corresponding author: Mahesh Kumar S ABSTRACT The number of people with Diabetes is increasing due to population growth aging urbanization and increasing prevalence of Obesity and Physical inactivity. Quantifying the prevalence of diabetes and the number of people affected by diabetes now and in the future is important to allow rational planning and allocation of resources. The study was conducted for a period of 6 months with 2 follow ups where 1 st follow up was held on the 15 th day and the II follow up on the next 30 th day of the patient enrolment. Patients were assessed for their KAP on baseline I and II follow ups. Intervention group patients were counseled through patient information leaflets. Keywords: Diabetes clinical Pharmacist Diabetic patients. INTRODUCTION The number of people with Diabetes is increasing due to population growth aging urbanization and increasing prevalence of Obesity and Physical inactivity. Quantifying the prevalence of diabetes and the number of people affected by diabetes now and in the future is important to allow rational planning and allocation of resources. The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8 in 2000 and 4.4 in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people 65 years of age. 1 The “Top 10” countries in the world in terms of the number of people with diabetes for 2010 and 2030 were estimated and at both time points the three countries with the largest number of people with diabetes are India China and the U.S. This picture is likely to change soon in light of the recent escalation in prevalence of diabetes 92.4 million adults in China. Roughly 80 of people with diabetes are in developing countries of which India and China share the larger contribution. It is estimated that the total number of people with diabetes in 2010 to be around 50.8 million in India rising to 87.0 million by 2030. According to the World Health Organization WHO criteria the prevalence of known diabetes was 5.6 and 2.7 among Urban and Rural areas respectively. 2 International Journal of Allied Medical Sciences and Clinical Research IJAMSCR

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 350 AIM The aim of the study was to evaluate the Impact of Clinical Pharmacist intervention on Knowledge Attitude and Practice of patients with Diabetes. MATERIALS AND METHODOLOGY The study was conducted for a period of 6 months with 2 follow ups where 1 st follow up was held on the 15 th day and the II follow up on the next 30 th day of the patient enrolment. Patients were assessed for their KAP on baseline I and II follow ups. Intervention group patients were counseled through patient information leaflets. KAP QUESTIONNAIRE It is a 27 question open ended questionnaire with 12 knowledge 8 attitude and 7 practice questions. Each correct answer was given a score 1 and the incorrect answer was given 0. The questionnaire covered causes symptoms complications of diabetes normal values of FBS and PPBS symptoms and immediate treatment for hypoglycaemia importance of dietary control and foot care in diabetes. PROCEDURE This is an interventional study where patients eligible were enrolled into the study after obtaining the consent. The data collection form was prepared and used. The KAP questionnaire consisted of 27 questions in both English and Telugu versions through which Knowledge Attitude and Practice of patients were assessed. A total of 102 DM patients were included in the study of which 52 were of Intervention and 50 were of Control groups. The patient details were collected using the case report form the questionnaire was asked to be filled by the patients and KAP was assessed. Every alternate patient was grouped under Control and Intervention groups. Both the Control and Intervention group patients were assessed for KAP in the baseline I and II Follow ups where I Follow up was held on the 15 th Day and the II Follow up on the next 30 th day. Patient counseling was done verbally and through Patient information leaflets only to the Intervention group patients. Only a few patients turned up for the follow ups and the other patients were contacted through phone. RESULTS AND DISCUSSION Majority of the Patients were in the Age group of 51- 60 yrs of which majority of them were males illiterate farmers with an annual income between 50000-1 00000 in Control group and 1 00000 in Intervention group. Table 1: Distribution of Demographic details of Diabetes Mellitus Patients Basic Variables Control Intervention N N Age in years 21-30 4 8 2 3.85 31-40 7 14 3 5.77 41-50 12 24 9 17.31 51-60 13 26 19 36.54 61-70 12 24 15 28.85 71-80 2 4 4 7.69 Gender Females 19 36.54 19 36.54 Males 31 63.46 33 63.46 Marital Status Married 49 98 51 98.08 Unmarried 1 2 1 1.92 Education Illiterates 27 54 39 75

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 351 Primary 15 30 7 13.46 High School 1 2 2 3.85 Intermediate 2 4 2 3.85 Graduates 5 10 2 3.85 Occupation Farmers 30 60 32 61.54 Govt. Employees 1 2 0 0 House Wives 13 26 12 23.08 Private Employees 6 12 7 13.46 Retired 0 0 1 1.92 Family Annual Income 50000 20 40 14 26.92 50000-100000 23 46 15 28.85 100000 7 14 23 44.23 Total 50 100 52 100 Table 2: comparison of results of KAP in control and intervention group Figure 1: Comparative distribution of quality of KAP in control and intervention group The p values were found to be more significant in the First and Second follow ups compared to the Baseline in the Intervention group whereas there was no such significance found in the Control group. KAP Control mean±sd P value Intervention mean±sd P value Baseline 11.26±3.26 12.23±4.08 1st Follow up 11.14±2.87 0.4441 16.81±3.57 P0.0001 2nd Follow up 11.46±2.84 0.249 20.81±2.64 P0.0001 0 5 10 15 20 25 Baseline 1st follow up 2nd follow up K A P Control Intervention

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 352 Table 3: comparison of results of KNOWLEDGE in control and intervention group Figure 2: Comparative distribution of knowledge Table 4: comparison of results of ATTITUDE in control and intervention group ATITUDE Control mean±sd P value Intervention mean±sd P value Baseline 3.58±1.14 4.37±1.89 1st follow up 3.6±1.12 0.7664 5.52±1.35 P0.0001 2nd follow up 3.68±1.13 0.1678 6.48±0.87 P0.0001 0 2 4 6 8 10 12 Baseline 1st follow up 2nd follow up K N O W L E D G E Control Intervention KNOWLEDGE Control mean±sd P value Intervention mean±sd P value Baseline 4.88±1.8 4.44±2.01 1st Follow up 4.83±1.53 0.7137 6.94±1.58 P0.0001 2nd Follow up 5.02±1.61 0.4733 8.54±1.41 P0.0001

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 353 Figure 3: comparative distribution of ATTITUDE Table 5: comparison of results of PRACTICE in control and intervention group Figure 4: Comparative distribution of PRACTICE The p values were found to be more significant in the First and second follow ups compared to the Baseline in the Intervention group whereas there was no such significance found in the Control group. COMPARISONS OF RESPONSE TO INDIVIDUAL KNOWLEDGE ATTITUDE AND PRACTICE QUESTIONS BY CONTROL AND INTERVENTION GROUPS KNOWLEDGE All the patients of Control group and majority of the patients of Intervention group gave right answers for 11 th and 12 th questions of Knowledge in Baseline First and Second follow ups. Almost none responded 0 1 2 3 4 5 6 7 8 Baseline 1st follow up 2nd follow up A T T I T U D E Control Intervention 0 1 2 3 4 5 6 7 8 Baseline 1st follow up 2nd follow up P R A C T I C E Control Intervention PRACTICE Control mean±sd P value Intervention mean±sd P value Baseline 2.68±0.87 3.42±1.59 1st follow up 2.74±0.83 0.4441 4.35±1.43 P0.0001 2nd follow up 2.84±0.77 0.0733 5.79±1 P0.0001

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 354 correctly for the 10 th question of Knowledge in Control group in Baseline First and Second follow ups while 1-4 patients of Intervention group responded correctly for the 10 th question of knowledge in Baseline First and Second follow ups. The number of patients of the Control group who gave the correct answers for 1-12 questions of Knowledge were 612. 4896. 2652. 510. 74. 48. 714. 2754. 2040. 00. 50100. 50100. respectively. The number of patients of the Intervention group who gave correct answers for 1-12 questions of Knowledge are 2446.15. 3057.69. 3057.69. 917.31. 1325. 11.92. 47.69. 1426.92. 917.31. 11.92. 4790.38. 4994.23. respectively. Knowledge of patients on Risk factors Symptoms of Hypoglycemia Immediate Treatment of Hypoglycemia was less compared to Knowledge on Symptoms and Complications of Diabetes in both Control and Intervention groups. However there was a significant improvement in Knowledge of Intervention group Patients in the First and Second follow ups. Figure 5: Comparisons of response to individual Knowledge questions by Control and Intervention groups ATTITUDE Majority of the patients of Control group responded correctly for the 8 th question of Attitude in Baseline while maximum response was given to 1 st question of Attitude in First and Second follow ups. Majority of the patients of Intervention group responded correctly for the 1 st question of Attitude in Baseline while maximum response was given to 6 th and 8 th questions of Attitude in First and Second follow ups. The number of patients of the Control group who gave the correct answers for 1-8 questions of Attitude are 4284 36 3876 1428 00 3876 12 4386 respectively. The number of patients of the Intervention group who gave the correct answers for 1-8 questions of Attitude are 4892.31 2446.15 3363.46 2650 1325 4280.77 59.62 3669.23 respectively. Most of the patients of the Control group believed that diabetics should not skip their medication even when the blood glucose is not too high and following a controlled low sugar and planned diet would help improve Diabetes. Most of the patients of the Intervention group believed that following a controlled low sugar and planned diet would help improve Diabetes and that once Diabetes is controlled dietary restrictions are still required. However there was a significant improvement in Attitude of Intervention group patients in the First and Second follow ups.

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 355 Figure 6: Comparisons of response to individual Attitude questions by Control and Intervention groups PRACTICE All the patients of Control group and majority of the patients of Intervention group responded correctly for the 3 rd question of practice in Baseline First and Second follow ups. The number of patients of the Control group who gave the correct answers for 1-7 questions of practice are 24 00 50100 918 24 2346 4896 respectively. The number of patients of the Intervention group who gave the correct answers for 1-7 questions of practice are 1528.85 1121.15 4280.77 2955.77 35.77 3261.54 4688.46 respectively. Most of the patients of both Control and Intervention groups followed a controlled and planned diet and took their medicines regularly. However there was a significant improvement in Practice of Intervention group patients in the First and Second follow ups. Figure 7: Comparisons of response to individual Practice questions by Control and Intervention groups

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 356 QUESTIONNAIRE KNOWLEDGE 1. Do you know that diabetes is a condition of high level of sugar in the blood than normal □Yes □No 2. Do you know that frequent hunger thirst and urination are symptoms of diabetes □Yes □No 3. Do you know that diabetes is associated with certain complications like retinopathy neuropathy nephropathy and cardiovascular complications □Yes □No 4. Do you know that people of age above 40 years old are at higher risk of getting diabetes □Yes □No 5. Do you know that the major causes of diabetes are hereditary and obesity □Yes □No 6. Do you know the symptoms of hypoglycemia □Yes □No 7. Do you know the immediate treatment of hypoglycemia □Yes □No 8. Do you know the normal value of fasting blood sugar level □Yes □No 9. Do you know the normal value of postprandial blood sugar level □Yes □No 10. Do you know that pancreatic ß-cells are affected when a person suffers with diabetes □Yes □No 11. Do you know that there is low healing of cuts and wounds in patients with diabetes □Yes □No 12. Do you know that diabetes is incurable and requires a lifelong administration of medication □Yes □No ATTITUDE 1. Do you think that following a controlled low sugar and planned diet will help improve diabetes □Yes □No 2. Do you think that regular exercise can help improve diabetes □Yes □No 3. Do you think missing doses of your diabetic medication will have a negative effect on your disease control □Yes □No 4. Do you think you should keep in touch with your physician □Yes □No 5. Do you think that keeping the blood sugar close to normal can help to prevent the complications of diabetes □Yes □No 6. Do you think that once diabetes is controlled eating restrictions are still required □Yes □No 7. Do you think that people with diabetes should control their weight □Yes □No 8. Diabetics should not skip their medications even when the blood glucose is not too high □Yes □No PRACTICE 1. Do you exercise regularly

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 357 □Yes □No 2. Do you check your feet regularly and go for regular eye check-up □Yes □No 3. Do you follow a controlled low sugar and planned diet □Yes □No 4. Do you keep in touch with your physician □Yes □No 5. Do you regularly monitor your body weight at home □Yes □No 6. Do you regularly monitor your blood glucose level at home □Yes □No 7. Do you take your medicines regularly □Yes □No REFERENCES 1. Sarah Wild et.al Global Prevalence of Diabetes Estimates for the year 2000 and projections for 2030 Diabetes Care volume 27 number 5 May 2004. 2. A Ramachandran et.al Current Status of Diabetes in India and Need for Novel Therapeutic Agents Journal Of Association Of Physicians Of India Vol. 58 Supplement to Japi June 2010. 3. V. Mohan et.al Epidemiology of type 2 diabetes Indian scenario Indian J Med Res 125 March 2007 pp 217- 230. 4. Zargar AH et. al Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent Diabetes Res Clin Pract 2000 47 135-6. 5. Ramachandran A et. al Diabetes Epidemiology Study Group in India DESI. High prevalence of diabetes and impaired glucose tolerance in India National Urban Diabetes Survey.Diabetologia 44 2001 1094-101. 6. Gupta A et.al Prevalence of diabetes impaired fasting glucose and insulin resistance syndrome in an urban Indian population Diabetes Res Clin Pract 61 2003 69-76. 7. Menon VU et. al Prevalence of known and undetected diabetes and associated risk factors in central Kerala ADEPS.Diabetes Res Clin Pract 2006 74 : 289-94.18 8. Raman Kutty V et.al High prevalence of type 2 diabetes in an urban settlement in Kerala India.Ethn Health4 1999 231-9. 9. Shah SK et.al High prevalence of type 2 diabetes in urban population in north eastern India Int J Diabetes Dev Countries 19 1999 144-7. 10. Mohan V et al Secular trends in the prevalence of diabetes and glucose tolerance in urban South India the Chennai Urban Rural Epidemiology Study CURES 17 Diabetologia 49 2006 11758. 11. American diabetes association Standards of Medical Care in Diabetes-2013 Diabetes Care Volume 36 Supplement 1 January 2013. 12. Joseph T. DiPiro Robert L. Talbert Gary C. Yee Gary R. Matzke Barbara G. Wells L. Michael Posey- Pharmacotherapy-A Pathophysiologic approach 6 th edition pg no-1338 1341 1343. 13. www.medecinsdumonde.org/ 14. Subish Palaian et.al Knowledge Attitude and Practice Outcomes: Evaluating the Impact of Counseling in Hospitalized Diabetic Patients in India Vol. 31 No. 7 July 2006. 15. Hinchageri SS et.al To evaluate the effectiveness of patient education on clinical outcome in hospitalized diabetic patients by clinical pharmacist- Journal of Drug Delivery Therapeutics 24 2012 147-151. 16. Mandana Goodarzi1 et.al Impact of distance education via mobile phone text messaging on knowledge attitude practice and self-efficacy of patients with type 2 diabetes mellitus in Iran Journal of Diabetes Metabolic Disorders 11 10 2012. 17. Viral N. Shah et.al Assessing the knowledge attitudes and practice of type 2 diabetes among patients of Saurashtra region Gujarat Int J Diabetes Dev Countries 293 2009 Jul-Aug 118–122.

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Mahesh K.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-33 2015 349-358 358 18. Nikhil P. Hawal et.al Knowledge attitude and behaviour regarding self-care practices among type 2 diabetes mellitus patients residing in an urban area of South India International Multidisciplinary Research Journal 212 2012 31-35. 19. Karam Padma et.al Evaluation of knowledge and self-care Practices in diabetic patients and their role in disease management National Journal of Community Medicine Vol 3 Issue 1 Jan-March 2012. 20. Naheed Gul knowledge attitudes and practices of type 2 diabetic patients J Ayub Med Coll Abbottabad 223 2010. How to cite this article: Mahesh Kumar S Praveen Kumar M Shiva Krishna G Amulya P Navaneetha K Nagireddy G A study on impact of clinical pharmacist intervention on knowledge attitude and practice of patients with diabetes in a tertiary care teaching hospital. Int J of Allied Med Sci and Clin Res 201533:349-358. Source of Support: Nil. Conflict of Interest: None declared.

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