Fig 3 - uploaded by Sai Krishna Gudi
Content may be subject to copyright.
![Bar graph showing QOL scores comparison between control and intervention groups. [y-axis: QOL score as per World Health Organization Quality of Life (WHOQOL); range = 0 to 100], [x-axis: follow-ups (1st to 3rd)].](profile/Sai-Krishna-Gudi/publication/319232046/figure/fig3/AS:571691435003905@1513313267106/Bar-graph-showing-QOL-scores-comparison-between-control-and-intervention-groups-y-axis.png)
Bar graph showing QOL scores comparison between control and intervention groups. [y-axis: QOL score as per World Health Organization Quality of Life (WHOQOL); range = 0 to 100], [x-axis: follow-ups (1st to 3rd)].
Source publication
Schizophrenia is a chronic mental-disorder and one of the top 10 causes of disability globally. Nearly 4.3 million people suffer from schizophrenia in India but very few visit a hospital for diagnosis or treatment. Of those patients who receive treatment, medication non-adherence and decreased quality of life (QOL) are the major problems. The objec...
Contexts in source publication
Context 1
... of patient's QOL between the control and interven- tion groups showed a mean improvement (mean ± Standard devi- ation) of 8.05 ± 5.32 in QOL (see Tables 4 and 5) of the intervention group over the control group (Fig. 3). Overall, there was a significant improvement in the mean QOL score of the inter- vention group when compared to that of the control group and a much higher mean difference as well (see Tables 2-4). Better QOL scores were observed in the intervention group over the con- trol group (Fig. 3). Similar finding was reported in a study ...
Context 2
... 4 and 5) of the intervention group over the control group (Fig. 3). Overall, there was a significant improvement in the mean QOL score of the inter- vention group when compared to that of the control group and a much higher mean difference as well (see Tables 2-4). Better QOL scores were observed in the intervention group over the con- trol group (Fig. 3). Similar finding was reported in a study carried out by Galupp et al. [10] wherein patients showed positive out- Table 1 Demographic details of the study population (Details are grouped according to age, gender and marital status of the enrolled patients (Values are expressed as numbers (N) for patients; percentage (%) is calculated ...
Citations
... The age range of the patients involved in these studies varied from 18 to 65. The sample sizes of the included studies ranged from 23 participants (Mishra et al., 2017) to 327 participants (Li et al., 2018) (Table I). ...
... In the fifth study conducted by Mishra et al. (2017), the intervention titled 'Pharmacist-led collaborative patient education' was implemented. This intervention involved pharmacists delivering specially designed patient information leaflets (PILs) to educate patients. ...
... Some studies featured a multidisciplinary team of professionals, comprising an experienced psychiatrist, psychotherapist, and social worker. Conversely, certain studies exclusively engaged psychiatrists (Ngoc et al., 2016), while one study enlisted pharmacists in delivering interventions to participants (Mishra et al., 2017). In addition to healthcare professionals, some studies involved researchers themselves as personnel directly providing interventions to participants (Hasan et al., 2015). ...
Not only antipsychotics but additional interventions such as education for people with schizophrenia are also needed to support optimal therapy. Studies with educational interventions have been conducted and show varied outcomes. The systematic review aimed to summarize and evaluate the effectiveness of studies regarding educational interventions for people with schizophrenia. Two electronic databases (PubMed and Science Direct) were used to find studies with criteria that were educational interventions for people with schizophrenia and focused on outcome measures related to improving knowledge, medication adherence, and other outcomes as an effect of educational interventions, randomized or randomized controlled trial studies, published between 2012 and 2022. The manual search of referenced articles was also applied. A literature search was conducted using the terms ("people with schizophrenia" OR "patients with schizophrenia") AND ("education" OR "knowledge") AND ("medication adherence" OR "medication compliance" OR "medication persistence"). Of the 666 studies, seven were eligible. Some educational interventions are part of a therapy program, while others are full psychoeducational programs that target not only the patient but also the patient's family. There was only one study that used counseling supported by leaflets delivered by a pharmacist. Another intervention used face-to-face interviews and discussions supplemented by modules or booklets, or giving booklets to patients and then following up by phone. Only one of the seven studies was effective in increasing patient knowledge. The rest did not measure knowledge but assessed other parameters, i.e., stigma and insight, symptoms, social functioning, relapse rate, or quality of life as the effect of educational intervention. Three studies showed a significant difference in improvement in medication adherence between the intervention and control groups; two studies were not significant, and the rest were unmeasured. It can be concluded that educational intervention had a positive effect on PwS and their families’ knowledge, improved medication adherence, and other outcomes as an effect of the educational intervention.
... Statistical Package for Social Sciences (SPSS) version 26 software was used to analyze the data obtained. We assumed a 10% difference in the primary outcome (Mishra et al., 2017), an alpha of 0.05, and a power of 80%, thus requiring a minimum sample size of 385 patients for both groups. However, considering the potential for losses to follow-up to be 10%, the intended sample size was 213 subjects per group over a 6-month study time period; the final sample size was 426 patients for both groups. ...
... improved with the intervention provided by the pharmacist. Findings similar to our study were reported in previous studies (Mishra et al., 2017;Saleem et al., 2018;Ali et al., 2019;Munsour et al., 2020). According to the research study, the quality of life of the intervention group increased much more, following educational counseling (Awaisu et al., 2012;Howyida et al., 2012;Kh et al., 2014). ...
Background: The study was designed to evaluate the impact of pharmacist-led
clinical interventions on the health-related quality of life among tuberculosis
patients in Pakistan.
Methods: A randomized, controlled prospective study was carried out in a
Pakistan Institute of Medical Sciences hospital tuberculosis (TB) control center.
Participants who visited the TB center between September 2020 and December
2021 were randomly assigned to two clusters, the usual care group (UC group) vs.
the intervention group (pharmaceutical care group), in a 1:1 ratio by a simple
envelope technique. In the intervention group, a patient received centered care
that encompassed informed decision-making, which can increase the quality of
care and monitoring of adverse drug events. However, the control group received
routine TB treatment at the hospital. The EuroQol-5D-3L instrument was used to
assess the health-related quality of life (HRQoL) at the baseline and in the third and
sixth months of the treatment time period.
Results: A total of 503 patients were eligible, of which only 426 patients were
included in this study. At the end of the study, n = 205 of the patients in the
intervention group and n = 185 of those in the control group were analyzed. In the
intervention group, the EQ-5D-3L health utility score improved significantly (p <
0.001) (from the baseline mean ± SD, 0.40 ± 0.36, to 6 months of treatment,
0.89 ± 0.09, while in the control group from 0.42 ± 0.35 to 0.78 ± 0.27). In
multivariate regression analysis, the variables that remained statistically associated
(p < 0.001) with the HRQoL (unstandardized β [95% confidence interval]) of the
control group were as follows: gender, female vs. male (-0.039 [-0.076 to
-0.003]); body weight, less than 40 kg vs. more than 40 kg (-0.109 [-0.195 to
-0.024]); patients with any comorbidity vs. without comorbidity (-0.136 [-0.252 to
-0.020]); and smokers vs. non-smokers (-0.204 [-0.291 to -0.118]). The study did not find any statistically significant associations between the intervention group’s
variables and the HRQoL.
Conclusion: Patient-centered care interventions led by pharmacists as part of care
coordination enhanced the HRQoL for TB patients significantly. According to this
study, clinical pharmacists should be included in the interdisciplinary clinical staff
for TB patient management.
... A study from India in a tertiary care setting for schizophrenia also showed that collaborative patient education by pharmacists and psychiatrists improved medication adherence and QOL [51]. ...
The symptoms of psychiatric infirmities have variability, and selected drug regimens for mental illness are comparatively complex and individualized; therefore, pharmacy services vary with respect to patients, diseases, healthcare settings, community structures, and countries. Clinical pharmacy services for mental health (MH) are continuously being upgraded. A structured search of the literature was performed in the Cochrane, PubMed (Medline), PsycINFO, Google scholar, Scopus, Science Direct, and Springer Links databases. The title and abstract of each retrieved article were evaluated for relevance. To remove uncertainty and ambiguity, the full-text articles were retrieved and examined for relevance. The articles were further assessed on the basis of inclusion and exclusion criteria. Narrative synthesis was performed, creating new categories and relevant subcategories and further subsections. The articles and the results were assessed for quality and bias. Pharmacists have a range of expertise in psychiatric care. The services can be classified as conventional, extended, and advanced pharmacy services. Conventional services include the quality use of medicines in healthcare settings and medication support services in communities that ensure medication adherence. Pharmacists perform extended roles in collaborative medication therapy management, multidisciplinary community mental health teams, collaborative care, patient education, home medication review, hospital-to-home transit, and screening services. In the USA, the role of pharmacists was advanced by prescribing as collaborative and interim prescribers. Australia launched an accredited program for psychiatric first-aid pharmacists. Pharmacists can provide mental care to rural populations using health technology. The role of pharmacists in MH is appreciated either independently or as a team member. Patients and healthcare providers rank the services of pharmacists in MH highly. Still, there is a margin for improvement in the training of pharmacists. Pharmacists cannot provide sufficient time to their patients. Public awareness about the role of pharmacists in MH needs more attention. Moreover, the training of psychiatric pharmacists should be standardized around the world.
... The oldest studies were published in 2011 28,29 and the most recent study was published in 2020. 30,31 Fifteen studies used a randomized controlled trial design with two arms, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] and one study used a randomized controlled trial design with three arms. 43 The studies were conducted in the United States, 29,43 several countries in East, West and South Asia such as China, 31,36 HongKong, 35,40,41 Japan; 34 Turkey, 33 Pakistan, 28 India, 32 and Vietnam; 42 as well as European countries such as Spain, 37 the Netherlands, 38 and Germany. ...
... 30,31 Fifteen studies used a randomized controlled trial design with two arms, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] and one study used a randomized controlled trial design with three arms. 43 The studies were conducted in the United States, 29,43 several countries in East, West and South Asia such as China, 31,36 HongKong, 35,40,41 Japan; 34 Turkey, 33 Pakistan, 28 India, 32 and Vietnam; 42 as well as European countries such as Spain, 37 the Netherlands, 38 and Germany. 30,39 Types of Intervention and Personnel Who Delivered the Intervention The Supervised Treatment in Outpatients for Schizophrenia (STOPS) program employs a drug supervisor who is appointed by the patient's family or close relatives. ...
... 29 Similarly, collaborative care 32 is a pharmacy-based intervention. Mishra et al, 32 used collaborative care with pharmacists and psychiatrists working together as a team to improve patient drug compliance and patient clinical outcomes. ...
Nonadherence to medications is very common in people with schizophrenia. Numerous methods have been implemented to improve medication adherence. The study aimed to determine what interventions have been used and to assess the effectiveness of these in improving medication adherence in people with schizophrenia. Two electronic databases (PubMed and Science Direct) and a manual search were used to locate RCT studies that examined interventions in medication adherence for schizophrenia, published between 2011 and 2022. The search was conducted using the terms (schizophrenia OR schizophrenic) AND (interventions OR adherence therapy) AND (medication adherence OR medication compliance). Sixteen studies were included, and relevant data were extracted and selected. Sixteen studies used interventions that involve family, health professionals (psychiatrists, psychologists, nurses, and pharmacists), SMS, and smart electronic reminders. Medication adherence was measured using medication refill records from hospital dispensing records or claim databases, electronic devices, plasma blood concentration, and participant self-reporting. Thirteen out of 15 studies showed significant improvements in adherence compared to routine care. The other three studies did not result in improved medication adherence. Interventions with diverse strategies delivered to individuals with schizophrenia showed the potential to reduce medication non-adherence in people with schizophrenia so that they can be utilized as an alternative to support treatment in people with schizophrenia in addition to antipsychotic medication. In future research strategies, it will be necessary to identify the main problems regarding nonadherence in people with schizophrenia individually and also identify the patient’s perception of medication, illness, and behavior when taking medication in order to determine the next intervention that will be appropriate based on the patient’s needs to improve adherence.
... These interventions were delivered by the pharmacist individually or as a group and focused on medication and disease state information and lifestyle modification recommendations, discussing the importance of medication adherence, and providing advice on how to manage medication side effects. Educational and counselling materials were developed based on published information such as consumer information leaflets (Mishra et al., 2017a(Mishra et al., , 2017b or information derived from the US pharmacopoeia (Kaukab et al., 2015) or guidelines from the American Society of Hospital Pharmacists (Greco, 1994). ...
... Six studies investigated changes in consumers' QOL. Different tools were used to assess QOL, but half of the studies (n = 3) used the WHO Quality of Life-BREF assessment and all showed significant QOL improvement (Mishra et al., 2017a(Mishra et al., , 2017bSingh et al., 2017). ...
... All RCTs had at least some concerns due to the nature of the intervention resulting in difficulty in blinding consumers and pharmacists. Six RCTs were assessed to have a high risk of bias relating to the 'measurement of the outcome' as they relied on self-report measures with non-blinded participants (Ahamad et al., 2019;Kaukab et al., 2015;Marques et al., 2013;Mishra et al., 2017aMishra et al., , 2017bSingh et al., 2017). Although there were 10 RCTs included in this review, only two specified the randomisation technique, and were rated as having low risk of bias in the randomisation process (Ahamad et al., 2019;Singh et al., 2017). ...
Objective:
People living with severe and persistent mental illness experience poorer physical health, often due to medication and preventable lifestyle factors, and exacerbated by barriers to accessing healthcare services. Pharmacists are well-positioned to improve the physical and mental health of this population. However, little is known about pharmacists' current practices when providing services to this population nor the impact of pharmacist-led interventions on consumer health outcomes. We undertook a systematic review to identify, describe and assess the effectiveness of pharmacist-led interventions for supporting people living with severe and persistent mental illness and the impact on consumer outcomes.
Methods:
MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts and ProQuest Dissertations and Theses were searched between January 1990 and April 2020. Full-text studies exploring pharmacist-led interventions in any setting for people living with severe and persistent mental illness were included. A risk of bias assessment was conducted.
Results:
A total of 37 studies were included. More than half of the pharmacist interventions were multifaceted. The most common components of pharmacist-led interventions included education and/or patient counselling, providing recommendations to healthcare professionals and conducting medication reviews. Multifaceted interventions demonstrated improvements in clinical outcomes, whereas single interventions focused mostly on consumer-reported outcomes. The methodological quality of included studies was moderate-to-high risk of bias and there was considerable heterogeneity in the study design, interventions described, and outcomes reported.
Conclusion:
There is evidence that pharmacist-led interventions improve consumer-reported and clinical outcomes for people living with severe and persistent mental illness. Pharmacists are capable and have a role in supporting people living with severe and persistent mental illness, either individually or as interprofessional collaborators with other healthcare professionals. Future research should attempt to better understand which particular intervention components have the greatest impact and also evaluate the implementation and long-term sustainability of such interventions.
... According to them choosing a hospital based patient care unit to conduct a research is possibly the best way to successfully implement the treatment approach. [18]. Another study by Shafie et. ...
Psychosocial dysfunction is expressly relevant to psychiatric disorders. Psychosocial dysfunction and Quality of Life (QOL) of the person with schizophrenia is being disrupted due to several regions. Schizophrenia has a synergistically corrosive effect on quality of life of the affected person that extends far beyond clinical symptoms. The aim of the study was to assess and compare the quality of life among the person with Schizophrenia and the level of their psychosocial dysfunction as well as severity of illness, so that an effective prevention strategy could be formulated in further. This study is a cross-sectional study consists of 60 individuals diagnosed with Schizophrenia. Tools: Socio-demographic and clinical checklist, PANSS, WHO-Quality of Life Scale and Dysfunctional Analysis Questionnaire. The result indicates that there is no significant difference between the genders of persons diagnosed with Schizophrenia on variables viz. Quality of life, psychosocial dysfunction. There was a significant negative correlation between quality of life and psychosocial dysfunction also there were significant negative correlation between severity of illness and quality of life. There was significant positive correlation between severity of illness and psychosocial dysfunction.
... According to the World Health Organization, prior to the pandemic, 50% of people with chronic disease in developed countries did not take their prescribed medication. 1 Two studies by Mishra et al 2,3 found that patients diagnosed with bipolar disorder and schizophrenia receiving pharmacist-led education had improved medication adherence and quality of life. Patient medication education groups (PMEGs) as defined by the College of Psychiatric and Neurologic Pharmacists allow patients the unique opportunity to interact with individuals who may share similar life experiences during the educational session. ...
... Hal ini sesuai dengan penelitian yang dilakukan oleh Mishra et al. pada tahun 2017 yang menyatakan bahwa diikutsertakannya apoteker sebagai tim dalam perawatan pasien skizofrenia secara langsung di India dapat membantu meningkatkan kepatuhan minum obat dan kualitas hidupnya. 17 Skizofrenia merupakan penyakit kronis yang kondisi fisik penderitanya cenderung tetap dan tidak ada perubahan. Penelitian oleh Gomes et al. pada tahun 2016 menyatakan bahwa pasien rawat jalan dengan skizofrenia mempunyai kualitas hidup lebih buruk serta aktivitas fisik yang lebih rendah dibanding dengan kontrol sehat. ...
Schizophrenia is a complex psychiatric disorder characterized by cognitive, emotion, perception, thinking, and behavior impairment. This research was conducted to determine the difference in level of compliance with schizophrenic patients before and after counseling by pharmacist, as well as to know their quality of life. The research method was one-group pretest-posttest with perspective design. Sampling of samples who met the inclusion criteria was done in the pharmaceutical installation of Menur Psychiatric Hospital from May to July 2018. Before data retrieval was done, all samples appropriated with the inclusion criteria were given an explanation about the purpose and description of the study, and after agreeing to be the subject, the patients or their family were obliged to fill informed consent. Interviews according to the Medication Adherence Rating Score (MARS) dan The World Health Organization Quality of Life (WHOQOL)-BREF questionnaires were done twice; the first was done upon arrival before counseling and the later was one month upon returning for control. Total of subjects was 100 people. The obtained data was analyzed using a different test (t-test). The result showed that there was a meaningful difference in patients’ compliance in taking drugs between pre and post counseling by the pharmacist (p=0.033). In terms of patients’ quality of life, results showed that the meaningful difference were only related to environmental domain (p=0.00), whereas no meaningful differences found on physical, mental and social domains (p>0.05).
... Similar to our findings, pharmacist-led patient education involving specially designed PILs in India improved patients' QoL. 27 A Brazilbased study evaluated the impact and retention of information from CMI on patients with gestational DM, which showed that there was good adherence with glucose testing. 28 Another study in Portugal involving 709 T2DM patients reported an improvement in medication adherence for patients who received validated WMI. ...
Background:
The importance of providing accurate medication information that can be easily comprehended by patients to subsequently best use their medication(s) has been widely reported in the literature. Patient information leaflet (PIL) is a supporting tool aiding patients to make decisions about their treatment plan and improve patient-clinician communication and thus medication adherence. PIL is the written document produced by the pharmaceutical manufacturers and packed with the medicine. The available PILs do not consider cultural and behavioral perspectives of diverse populations residing in a country like Qatar. Consumer medication information (CMI) is written information about prescription drugs developed by organizations or individuals other than a drug's manufacturer that is intended for distribution to consumers at the time of drug dispensing.
Objective:
To investigate the impact of customized CMI (C-CMI) on health-related quality of life (HRQoL) among type 2 diabetes mellitus (T2DM) patients in Qatar.
Methods:
This was a randomized controlled intervention study, in which the intervention group patients received C-CMI and the control group patients received usual care. HRQoL was measured using the EQ-5D-5L questionnaire and EQ visual analog scale (EQ-VAS) at three intervals [i.e. baseline, after 3 months and 6 months].
Results:
The EQ-5D-5L index value for the intervention group exhibited sustained improvement from baseline to the third visit. There was a statistically significant difference between groups in the HRQoL utility value (represented as EQ index) at 6 months (0.939 vs. 0.796; p = 0.019). Similarly, the intervention group compared with the control group had significantly greater EQ-VAS at 6 months (90% vs. 80%; p = 0.003).
Conclusions:
The impact of C-CMI on health outcomes of T2DM patients in Qatar reported improvement in HRQoL indicators among the intervention patients. The study built a platform for health policymakers and regulatory agencies to consider the provision of C-CMI in multiple languages.
... Unfortunately, such programs have not been launched in most developing countries, such as India, for diverse reasons including the reluctance of general practitioners to follow recommendations made by pharmacists, a lack of awareness regarding HMR services among the public, patients' conflicts of interest and privacy issues that affect their willingness to disclose their disease status and medication use, and linguistic and cultural diversity [5,6]. However, a few studies have investigated the influence of pharmacist-provided patient counseling services and found that such counseling services led to significant improvements in health outcomes in patients with chronic diseases [21][22][23][24][25]. The professional bodies in Australia have developed guidelines on HMR activities to assist community pharmacists in exercising professional judg-ment in individual health care circumstances and to promote the quality use of medicines to achieve better patient care. ...
Objectives:
To address and elucidate the impact of pharmacist-led Home Medicines Review (HMR) in identifying various drug-related problems (DRPs) among the elderly population in homecare settings.
Methods:
A comprehensive systematic search was performed using the scientific electronic databases like PubMed, Scopus, Embase, and Web of Science for the studies published between 1 January 2008 to 31 December 2018 pertaining to HMR services by the pharmacist in identifying drug-related problems.
Results:
In total, 4292 studies were retrieved from the searches; and of these, 24 were excluded as they were duplicates. Titles and abstracts were screened for the remaining 4268 studies; and of them, 4239 articles were excluded due to the extraneous nature of the titles and/or abstracts. Subsequently, 29 full-text articles were assessed, and 19 were removed for lacking the outcome of interest and/or not satisfying the study's inclusion criteria. At last, ten studies were included in the review. The pharmacist identified a highly significant count of DRPs through HMR services across all the studies. Of them, the most common type of DRPs were, potential drug-drug interactions, serious adverse drug reactions, need for an additional drug, inappropriate medication use, non-adherence, untreated indication, overdose, and usage of expired medications.
Conclusion:
HMR is a novel and extended role of the pharmacist, which is efficient in identifying and resolving the DRPs which could eventually minimize the patient’s health-related cost & burden, and thus enhance the quality of life and well-being among the elderly.
Keywords: Pharmacists; Drug-Related Side Effects and Adverse Reactions; Drug Interactions; Aged; Frail Elderly
