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94 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com International Journal of Universal Pharmacy and Bio Sciences 34: July-August 2014 INTERNATIONAL JOURNAL OF UNIVERSAL PHARMACY AND BIO SCIENCES IMPACT FACTOR 1.89 ICV 5.13 Bio Sciences Research Article …… ASSESSMENT OF THE IMPACT OF PHARMACIST PROVIDED PATIENT COUNSELING ON TREATMENT OUTCOMES AND QUALITY OF LIFE IN HYPERTENSIVE AND DIABETES MELLITUS TYPE-II PATIENTS Dr.D.NagaSatishBabuK.MallikarjunReddy G.RaghavendraKumar D.NarasimharaoDr.J.N.SureshKumar T. Swarupa Rani Department of Pharmacy practice Narasaraopet Institute of Pharmaceutical Sciences Narasaraopet Guntur D.t A.P. KEYWORDS: Pharmacists Hypertension Blood pressure Blood sugar level. For Correspondence: Dr. D.Naga Satish Babu Address: Department of Pharmacy practice Narasaraopet Institute of Pharmaceutical Sciences Narasaraopet Guntur D.t A.P. Email ID: babusatish1437gmail.c om ABSTRACT Pharmacists today are aware that the practice of pharmacy has evolved over the years to include not only preparation and dispensing of medication to patients but also interaction with patients and other health care providers throughout the provision of pharmaceutical care. Health related quality of life is increasingly viewed as a therapeutic outcome and is gradually gaining the same level of importance as clinical or physiological outcome parameters. eg: blood pressure blood sugar levels this study aimed to assess impact of pharmacist provided patient education on treatment out comes KAP QOL of patients with coexisting diabetes and hypertension. Our study confirms that improvement in knowledge of the disease and its management had positive impact on treatment outcomes and quality of life PCS. At the same time it is noticed that counseling had no effect on mental component summary of the patient’s quality of life. This study thus emphasis the impact of patient counseling on KAP QOL in patient with diabetes and hypertension.

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95 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com INTRODUCTION: The most important role of patient counseling is to improve quality of life and provide quality care for patients. The occurrence of so called “drug misadventures 1 ” adverse effects side effects drug interactions and errors in use of medicationand non adherence to treatment program reduce quality of life and interfere with quality care. 2 Counseling is essentially a helping process. In order to help patients the pharmacist must also educate them about their illness and their medications. Thus patient counseling can be stated as “patient medication counseling is pharmacist’s talking with patients about the medications they are intended to take in order to educate them about medication related issues and to help them get the most benefit from their medication. 3 DIABETES MELLITUS: Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar glucose levels that result from defects in insulin secretion or action or both. Normally blood glucose levels are tightly controlled by insulin a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates for example after eating food insulin is released from the pancreas to normalize the glucose level. In patients with diabetes the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition meaning that although it can be controlled it lasts a lifetime. DIABETES WITH HYPERTENSION: HYPERTENSION: It is a condition of high blood pressure i.e pressure of blood in arteries. Normal blood pressure is 120/80mmHg. Epidemiology: Diabetes and hypertension coexist in approximately 40 to 60 of patients with type 2 diabetes. Diabetics subjects have a 1.5 – 3 times increased prevalence of hypertension compared to non-diabetics with 50 of adults with diabetes having hypertension at the time of diagnosis. The coexistence of these two conditions is associated with increased risk of retinopathy nephropathy and cardiovascular disease. Hypertension is twice as prevalent in diabetic compared with non- diabetic patients. Hypertension is a major factor that contributes to the development of the vascular complications of diabetes mellitus mellitus type II patients which primarily include atherosclerosis nephropathy and retinopathy. The mechanism of the pathophysiological effects of hypertension lies at the cellular level in the blood vessel wall which intimately involves the function and interaction of the endothelial and vascular smooth muscle cells. Both hypertension and diabetes mellitus alter endothelial cell structure and function. In large and medium size vessels and in the kidney endothelial dysfunction leads to enhanced growth and vasoconstriction of vascular smooth muscle cells and mesangial cells respectively. These changes in the cells of smooth muscle lineage play a key role in the development of both atherosclerosis and glomerulosclerosis. In diabetic retinopathy

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96 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com damage and altered growth of retinal capillary endothelial cells is the major pathophysiological insult leading to proliferative lesions of the retina. Thus the endothelium emerges as a key target organ of damage in diabetes mellitus this damage is enhanced in the presence of hypertension. Health Related Quality Of Life HRQoL: One of the most important goals of all health interventions is to improve the quality of life of persons affected by disease. 4 In the domain of physical health and illness quality of life refers to participant’s self-evaluation of health or on their perceived functional status and well-being. In chronic conditions such as hypertension and diabetes health-related quality of life HRQoL is an especially important outcome given their lifelong nature and the need for daily self-management. HRQoL has been found to be poorer in diabetic participants than in the general population especially in the domains of self perceived physical health while findings on domains of psychosocial functioning vary between studies 5 . Hypertension has also been shown to be associated with negative outcomes in HRQoL especially in the domain of subjectively perceived general health although its impact on HRQoL is usually less adverse than that of other chronic diseases. Although studies comparing the effects of different chronic diseases generally point to a conclusion that hypertension has less adverse effects on HRQoL than diabetes the magnitude of effect is more in case of coexistence of diabetes and hypertension 6 . Specific aims of the study include:  To provide information to the patients about the advances in the management of diabetes mellitus type II and hypertension.  To assess the patient’s Knowledge Attitude Practice with respect to the disease.  To assess the quality of life and impact of patient counseling on it. METHODOLOGY: STUDY SITE: The study was conducted in Department of Medicine Mahatma Gandhi Medical Hospital Warangal and Andhra Pradesh. It is a 1000 bedded multispecialty teaching hospital. STUDY PERIOD: This study was performed for a span of 6 months from Nov2010-Apr-2011. STUDY DESIGN: 1. It is a randomized prospective controlled study. 2. Patients selected were divided into control and test groups. 3. Patients in the test group were counseled and given information about the management of the disease whereas control group receive the information only at the end of the study. 4. The follow up was carried out over a period of six months in which the KAP and quality of life of the patients was assessed.

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97 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com 5. The scores were evaluated and statistically analysed. 6. A comparative study is made between the control and test groups. Selection of patients: Inclusion criteria: 1. Patients with diabetes mellitus type-II and hypertension. 2. Patients with age group of above 20 years. 3. Outpatients and inpatients are included. Exclusion criteria: 1. Patients with an age group below 20 years. 2. Patients with hepatic disease and patients undergone complicated surgeries. 3. Pregnant women and lactating mothers. RESULTS: Using inclusion and exclusion criteria a total of 55patients were enrolled in the study and were randomized to control and test groups. Of the 55 enrolled 47patients 23 control and 24 test who completed all follow-up visits were included in analysis. The other 8 patients withdrew from the study for unknown reasons. DEMOGRAPHICS: Age and Sex: Out of 4t patients included in the study 1940.43 were female and 2859.57 were male. Graph 1: Sex Distribution The age distribution was as follows 1. 30 to 40 years of age are 04 patients 12.1 2. 41 to 50 years of age are 13 patients 31.7 3. 51 to 60 years of age are 18 patients 36.5 50.57 40.43 MALE FEMALE

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98 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com 4. 61 to 70 years of age are 11patients 19.5 5. 71 to 80 years of age are 01 patient 2.12 Graph 2: Age Distribution KAP STUDY: KAP questionnaire contains a total of 25 questions of which 18 are knowledge questions and 7 are attitude/practice question 7 . EFFECT OF PATIENT COUNSELING ON KNOWLEDGE OUTCOMES: The mean knowledge scores for control group before counseling was 10.76±0.32 and after counseling was 12.10±0.234. The mean knowledge scores for test group before counseling was 9.7±0.317 and after counseling was 11.95±0.5355. Graph 3: EFFECT OF PATIENT COUNSELING ON KNOWLEDGE OUTCOMES 8.50 27.60 38.30 23.45 2.12 AGE DISTRIBUTION PERCENTAGE 30-40 41-50 51-60 61-70 71-80 9.762 10.1 8.7 11.95 0 2 4 6 8 10 12 14 control test Mean knowledge score EFFECT OF PATIENT COUNSELING ON KNOWLEDGE OUTCOMES pre counseling post counseling

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99 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com EFFECT OF PATIENT COUNSELING ON ATITUDE AND PRACTICE OUTCOMES: The mean attitude /practice scores before counseling and after counseling were 3.51±0.2809 4.210±0.2026 respectively for control group. The mean attitude/practice scores before counseling and after counseling were 3.8±2.2 5.1±0.1433 respectively for test group. Graph 4: EFFECT OF PATIENT COUNSELING ON ATITUDE AND PRACTICE OUTCOMES QUALITY OF LIFE: Quality of life results were expressed in terms of two meta scores: Physical Component Summary PCS Mental Component SummaryMCS EFFECT OF PATIENT COUNSELING ON PHYSICAL COMPONENT SUMMARY PCS: The pre counseling and post counseling PCS mean scores were 42.48±.136 44.77±1.342 respectively for control group. The pre counseling and post counseling PCS mean scores were 44.19±1.342 49.71±0.622 respectively for test group. 3.571 3.81 3.2 5.1 0 1 2 3 4 5 6 control test Mean attitude and practice score EFFECT OF PATIENT COUNSELING ON ATTITUDE AND PRACTICE OUTCOMES pre counseling post counseling

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100 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com Graph 5: EFFECT OF PATIENT COUNSELING ON PHYSICAL COMPONENT SUMMARY PCS: EFFECT OF PATIENT COUNSELING ON MENTAL COMPONENT SUMMARY MCS: The MCS mean scores before counseling and after counseling were found to be 46.68±1.125 46.33±0.910 respectively for control group. The MCS mean scores before counseling and after counseling were found to be 47.78±1.761 48.55±1.168. Graph6: EFFECT OF PATIENT COUNSELING ON MENTAL COMPONENT SUMMARY MCS: 42.48 44.77 44.19 49.71 38 40 42 44 46 48 50 52 control test Mean PCS score EFFECT OF PATIENT COUNSELING ON QUALITY OF LIFE PCS pre counseling post counseling 46.68 46.33 47.78 48.55 45 45.5 46 46.5 47 47.5 48 48.5 49 control test Mean MCS score EFFECT OF PATIENT COUNSELING ON QUALITY OF LIFE MCS pre counseling post counseling

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101 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com BLOOD PREESURE AND BLOOD SUGAR LEVELS: EFFECT OF PATIENT COUNSELING ON BLOOD PRESSURE LEVELS SYSTOLIC: The mean systolic blood pressure levels were 150.8± 3.1 146.0±2.34 for pre counseling and post counseling control groups. The mean systolic blood pressure levels were 145.8±2.32 140.8±1.92 for pre counseling and post counseling test groups. Graph 7: EFFECT OF PATIENT COUNSELING ON SYSTOLIC BLOOD PRESSURE EFFECT OF PATIENT COUNSELING ON BLOOD PRESSURE LEVELS DIASTOLIC: The mean diastolic blood pressure levels were 99.10±7.2. 94.7.±5.26 for pre counseling and post counseling control groups. The mean diastolic blood pressure levels were 105.4.±4.2 90.5±5.4.0 for pre counseling and post counseling test groups. Graph 8: EFFECT OF PATIENT COUNSELING ON DIASTOLIC BLOOD PRESSURE 134 136 138 140 142 144 146 148 150 152 test control test control pre counseling post counseling 145.8 150.8 140.8 146 88 90 92 94 96 98 100 102 104 106 TEST CONTROL TEST CONTROL PRE COUNCELLING POST COUNCELLING 105.4 99.1 99.5 94.7

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102 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com EFFECT OF PATIENT COUNSELING ON BLOOD SUGAR LEVELS: The mean blood sugar levels before counseling are like FBS-140.6±1.93 RBS-174.4 ±6.5 and after counseling were FBS-137±2.25 RBS-172.8±5.28for control group. The mean blood sugar levels before counseling are like FBS-175.3±5.32 RBS-195.9±7.62 and after counseling were found to be FBS-161.6±4.84 170.0±7.05 for test group. Graph 9: EFFECT OF PATIENT COUNSELING ON BLOOD SUGAR LEVELS RBS+FBS CONCLUSION: Health related quality of life is increasingly viewed as a therapeutic outcome and is gradually gaining the same level of importance as clinical or physiological outcome parameters. eg: blood pressure blood sugar levels this study aimed to assess impact of pharmacist provided patient education on treatment out comes KAP QOL of patients with coexisting diabetes and hypertension. At base line all patients had poor knowledge and attitude towards their disease and thus poor QOL PCS MCS. At the end of the study patients of test group received extensive counseling regarding their disease and its management showed greater improvement in treatment outcomes blood pressure blood sugar levels KAP QOL than in patients in control group. Our study confirms that improvement in knowledge of the disease and its management had positive impact on treatment outcomes and quality of life PCS. At the same time it is noticed that counseling had no effect on mental component summary of the patient’s quality of life. This study thus emphasis the impact of patient counseling on KAP QOL in patient with diabetes and hypertension. 0 20 40 60 80 100 120 140 160 180 200 TEST CONTROL TEST CONTROL PRE COUNSELING POST COUNSELING 195.9 174.4 170 172.8 175.3 140.6 161.6 137 RBS FBS

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103 | P a g e International Standard Serial Number ISSN: 2319-8141 Full Text Available On www.ijupbs.com BIBLIOGRAPHY 1. Melainee J Rantucci Pharmacists talking with patients: A guide to patient counseling 2009. 2. Robert S Beandesley Carole L KimberlinCommunication skills in Pharmacy Practice 2010. 3. G. Parthasarathi Karin Nyfort-Hansen Milap c Nahata A Textbook of Clinical Pharmacy Practice: Essential concepts and skills2010:43 -53. 4. Charles Richard Boddington Joyee Hannah M Individual quality of life: Approaches to conceptualization and assessment 1999. 5. International classification of functioning disability and health: ICF World Health Organisation 2010. 6. Stuart R Walker Rachel Roser Quality of life Assessment: Key issues in the 1990’s 199320072010. 7. K. Kaliyaperumal Guidelines for conducting a Knowledge Attitude and Practice KAP study http://laico.org/v2020resource/files/guideline_kap_Jan_mar04.pdf.

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