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THE ROLES OF PHARMACISTS IN CARE OPTIMIZATION FOR SCHIZOPHRENIC PATIENTS IN FEDERAL NEURO-PSYCHIATRIC HOSPITAL MAIDUGURI, NORTH-EASTERN NIGERIA
Abstract:
Provision of pharmaceutical care to patients suffering from schizophrenia posses special challenges due to complexity of the disease state, stigmatization and the side effects associated with antipsychotics. The aim of this study was to evaluate the roles of pharmacists in care optimization for schizophrenic patients. The perception of schizophrenic patients to the roles of pharmacists in care optimization was evaluated under 3 domains: managing therapy, interpersonal relationship and general satisfaction. A total of 160 patients were asked to rate their perception of pharmacists’ roles in care optimization by scoring from one (1) to five (5), with 5 indicating the highest score. Their perception was evaluated and results were described using percentages. Furthermore, the association of socio- demographic characteristics of schizophrenic patients with their perception of pharmacists’ roles in care optimization was determined using logistic regression. Additionally, the perception of other health care professionals of pharmacists’ roles in care optimization for schizophrenic patients was evaluated using a self administered questionnaire of a five point likert scale (strongly disagreed, disagreed, undecided, agreed and strongly agreed). Results were presented in percentages. Also, the extent to which pharmacists perform their roles regarding care optimization was also evaluated using a self administered questionnaire consisting of a five point likert scale (never, rarely, sometimes, most of the time and always) and results were also presented in percentages. It was found that a little over half of schizophrenic patients interviewed had poor perception of pharmacists’ roles in care optimization. However, there was no significant difference between the proportion of schizophrenic patients that perceived the roles of pharmacists as being good and those that perceived it as being poor (x2 =2.500, p=0.114, df=1). In the different domains on the perception of schizophrenic patients, managing therapy had the least score (48.6%). vii Socio-demographic characteristics of schizophrenic patients such as age, gender and marital status do not show significant correlation with the perception of pharmacists’ roles in care optimization while level of education: secondary level of education (p=0.001), tertiary level of education (p= 0.001) showed significant correlation and the odd to perceive the role of pharmacists increases with increasing level of education (Primary; OR= 1.471, Secondary; OR= 4.927, Tertiary; OR=7.293). Majority of other health care professionals positively perceived pharmacists role in care optimization for schizophrenic patients with significant difference (p≤ 0.05) across all assessed items. Pharmacists reported varying degrees of involvement in care optimization for schizophrenic patients, including – rarely, sometimes and most of the time. It can therefore be concluded that a little over half of schizophrenic patients had poor perceptions of the roles of pharmacists in care optimization. Level of education was the only socio-demographic characteristic with significant correlation to schizophrenic patients’ perceptions. Other health care professionals positively perceived the roles of pharmacists in care optimization for schizophrenic patients. Majority of the pharmacists were sometimes or most of the times involved in care optimization for schizophrenic patients, while only a few proportion of the pharmacists were always involved in care optimization in the different aspects.
TABLE OF CONTENTS
Declaration…………………………………………………………………………………………………………………………………. ii
Certification……………………………………………………………………………………………………………………………….. iii
Dedication…………………………………………………………………………………………………………………………………… iv
Acknowledgement……………………………………………………………………………………………………………………. v
Abstract……………………………………………………………………………………………………………………………………….. vi
Table of Contents…………………………………………………………………………………………………………………….. viii
List of Figures……………………………………………………………………………………………………………………………. xiii
List of Tables……………………………………………………………………………………………………………………………… xiv
List of Appendices…………………………………………………………………………………………………………………… xv
List of Abbreviations and Acronyms……………………………………………………………………………….. xvi
CHAPTER ONE……………………………………………………………………………………………………………………… 1
1.0 INTRODUCTION…………………………………………………………………………………………………….. 1
1.1 Background of the Study………………………………………………………………………………………… 1
1.2 Statement of the Study Problem…………………………………………………………………………… 2
1.3 Justification………………………………………………………………………………………………………………….. 2
1.4 Aim of the Study………………………………………………………………………………………………………… 3
1.5 Specific Objectives…………………………………………………………………………………………………….. 3
1.6 Research Questions……………………………………………………………………………………………………. 4
1.7 Research Hypothesis…………………………………………………………………………………………………. 4
CHAPTER TWO…………………………………………………………………………………………………………………….. 5
2.0 LITERATURE REVIEW………………………………………………………………………………………… 5
2.1 Pharmaceutical Care Concepts……………………………………………………………………………….. 5
2.1.1 The objectives of pharmaceutical care……………………………………………………………………….. 6
2.1.2 The roles of pharmacists and collaboration with other health care
professionals…………………………………………………………………………………………………………………….. 7
2.1.3 Principles of practice for pharmaceutical care…………………………………………………………. 10
2.1.4 Steps in providing pharmaceutical care to patients………………………………………………… 13
2.1.5 Benefits of pharmaceutical care………………………………………………………………………………….. 15
2.1.6 Barriers to the implementation of pharmaceutical care…………………………………………. 16
2.2 Schizophrenia and its Management…………………………………………………………………………… 17
2.2.1 Epidemiology……………………………………………………………………………………………………………………. 18
2.2.2 Etiology……………………………………………………………………………………………………………………………… 18
2.2.3 Pathophysiology………………………………………………………………………………………………………………. 19
2.2.4 Symptoms………………………………………………………………………………………………………………………….. 20
2.2.5 Clinical presentation……………………………………………………………………………………………………….. 20
2.2.6 Management of schizophrenia……………………………………………………………………………………… 22
2.2.7 Non pharmacologic therapy………………………………………………………………………………………….. 22
2.2.8 Pharmacologic therapy…………………………………………………………………………………………………… 23
2.3 Relevance of Pharmaceutical Care in Schizophrenic Patients…………………….. 25
2.3.1 Advising, prescribing and auditing pharmacotherapy in schizophrenia…………… 26
CHAPTER THREE……………………………………………………………………………………………………………….. 28
3.0 RESEARCH METHODOLOGY………………………………………………………………………….. 28
3.1 Description of the Study Area………………………………………………………………………………….. 28
3.2 Sample Size Determination……………………………………………………………………………………….. 29
3.2.1 Schizophrenic patients……………………………………………………………………………………………………. 29
3.2.2 Other health care professionals……………………………………………………………………………………. 29
3.2.3 Pharmacists……………………………………………………………………………………………………………………….. 30
3.3 Study Population…………………………………………………………………………………………………………… 30
3.3.1 Inclusion criteria………………………………………………………………………………………………………………. 31
3.3.2 Exclusion criteria……………………………………………………………………………………………………………… 31
3.4 Sample Selection……………………………………………………………………………………………………………. 32
3.5 Ethical Considerations………………………………………………………………………………………………… 33
- 6 Study Design…………………………………………………………………………………………………………………… 33
3.7 Data Instrument…………………………………………………………………………………………………………….. 34
3.7.1 Questionnaire development………………………………………………………………………………………….. 34
3.7.2 Questionnaire validation process………………………………………………………………………………… 34
3.8 Data Collection………………………………………………………………………………………………………………. 35
3.9 Data Analysis and Presentation………………………………………………………………………………. 3
CHAPTER FOUR………………………………………………………………………………………………………………….. 36
4.0 RESULTS……………………………………………………………………………………………………………………….. 36
4.1 Distribution of Schizophrenic Patients’ According to their Socio-
Demographic Characteristics in Federal Neuro Psychiatric Hospital
Maiduguri……………………………………………………………………………………………………………………….. 36
4.2 Perceptions of Schizophrenic Patients regarding Pharmacists’ roles in
Care Optimization………………………………………………………………………………………………………… 38
4.2.1 Distribution of schizophrenic patients’ perception scores of the roles of
pharmacists in care optimization across the three activity domains in
federal neuro psychiatric hospital maiduguri………………………………………………………….. 38
4.2.2 Mean perception scores of schizophrenic patients’ perception of pharmacists’
roles across all assessed domains in federal neuro psychiatric hospital maiduguri………………………………………………………………………………………………………………………….. 40
4.2.3 Schizophrenic patients’ perception of pharmacist roles across assessed domains in federal neuro psychiatric hospital maiduguri……………………………………. 42
4.3 Association between Schizophrenic Patients’ Perception of Pharmacists’
Roles and Socio-Demographic Characteristics in Federal Neuro
Psychiatric Hospital Maiduguri………………………………………………………………………………. 44
4.4 Perception of Other Health Care Professionals of Pharmacists’ Roles
in Care Optimization for Schizophrenic Patients in Federal Neuro
Psychiatric Hospital Maiduguri………………………………………………………………………………. 46
4.4.1 Perception of other health care professionals of pharmacists’ roles in the
area of patient counselling, source of drug literature, patient supplies,
Pharmacists’ competence and documentation of care in Federal Neuro Psychiatric Hospital Maiduguri……………………………………………………………………… 46
4.4.2 Perception of other health care professionals on pharmacists’ roles in
the area of therapeutic plan development, implementation, monitoring
and evaluation in Federal Neuro Psychiatric Hospital Maiduguri……………………. 48
4.4.3 Perception of other health care professionals of pharmacist’s roles
in the area of improving patients’ quality of care in Federal Neuro
Psychiatric Hospital Maiduguri………………………………………………………………………………….. 50
4.5 The Role of Pharmacists and the Extent of Care Optimization in
Schizophrenic Patients……………………………………………………………………………………………….. 52
4.5.1 Pharmacists’ roles and extent of involvement in therapeutic plan
formulation, implementation, modification, monitoring, evaluation
and documentation of antipsychotic therapy in Federal Neuro
Psychiatric Hospital Maiduguri…………………………………………………………………………………. 52
4.5.2 Pharmacists’ roles in schizophrenic patients counselling in Federal
Neuro Psychiatric Hospital Maiduguri……………………………………………………………………. 54
4.5.3 Pharmacists’ roles in their relationship with other health care
Professionals in Federal Neuro Psychiatric Hospital Maiduguri……………………….. 56
CHAPTER FIVE…………………………………………………………………………………………………………………….. 58
5.0 DISCUSSION………………………………………………………………………………………………………………… 58
5.1 Limitation of the Study……………………………………………………………………………………………….. 63
CHAPTER SIX………………………………………………………………………………………………………………………… 64
6.0 CONCLUSION AND RECOMMENDATIONS…………………………………………….. 64
6.1 Conclusion……………………………………………………………………………………………………………………….. 64
6.2 Contribution to Knowledge………………………………………………………………………………………. 64
6.3 Recommendations…………………………………………………………………………………………………………. 65
REFRENCES…………………………………………………………………………………………………………………………… 66
APPENDICES………………………………………………………………………………………………………………………….. 71
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of the Study
Schizophrenia is one of the most complex and challenging of psychiatric disorders. It represents a heterogeneous syndrome of disorganized and bizarre thoughts, delusions, hallucinations, inappropriate affect, and impaired psychosocial functioning (American Psychiatric Association, 2000).
It is a chronic mental disorder affecting a person’s thinking, feeling and behaviour (Tandon and Maj, 2008). Schizophrenia is classified based on the presenting symptoms as disorganised, catatonic, paranoid or undifferentiated and it is caused by alterations in the brain structure and function, a probable developmental disorder due to improper maturation of the nervous system (Schizophrenia Research Institute Australia, 2017).
From the time that Kraepelin first described dementia praecox in 1896 until publication of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) in 2000, the description of this illness has continuously evolved (American Psychiatric Association, 2000).
Pharmaceutical care (PC) is defined as a responsible provision of drug therapy for the purpose of achieving definite outcomes that improve patient’s quality of life. The outcomes includes: cure of a disease, elimination or reduction of patients’ symptoms and arresting or slowing of a disease process or symptom. Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other professionals in designing, implementing, and monitoring a therapeutic procedure that will produce specific therapeutic outcomes for the patient. These involves: identifying potential and actual drug-related problem, resolving actual drug related problems and preventing drug related problems (Hepler and Strand, 1990).
The shift of pharmacy practice from product oriented to patient oriented results in greater interaction between pharmacists and other medical professionals and this has resulted into safer, more effective and less costly therapy in new era of patient care (Mohammed et al., 2014).
1.2 Statement of the Study Problem
It is estimated that approximately 50% of patients with schizophrenia do not take their prescribed medications as directed (Lacro et al., 2002). Study also revealed that 74% of patients with schizophrenia had discontinued medication within 18 months due to non efficacy and intolerable side effects (Lieberman et al., 2005).
1.3 Justification
Pharmaceutical care is a patient centred and outcome oriented pharmacy practice with the goal to optimize health related quality of life and to achieve positive outcomes within realistic economic expenditures, but it is apparently a theoretical statement in many hospital settings in Nigeria (Mohammed, 2014).
The prescription, dispensing, administration and monitoring of antipsychotics requires proper implementation of pharmaceutical care which requires the pharmacist to work in concert with the patient and the patient’s other healthcare providers to promote health, to prevent disease, and to assess, monitor, initiate, and modify medication use to assure that drug therapy regimens are safe and effective (Hepler and Strand,1990).
Various drug treatment options, frequent occurrence of side effects and low antipsychotic medication compliance, give the pharmacists an important role to play in the overall successful treatment of patients with schizophrenia (Rijcken et al., 2002).
Patient perception has gained much attention and has been considered as an integral component in the determination of care outcomes (Rosenthal and Shannon, 1997).
1.4 Aim of the Study
The aim of this study was to evaluate the pharmacists’ roles in care optimization for Schizophrenic patients.
1.5 Specific Objectives
- To identify the perception of schizophrenic patients regarding pharmacists’ roles in care optimization.
- To determine whether socio demographic factors explains the perception of schizophrenic patients regarding pharmacists’ roles.
- To identify the perception of other health care professionals on pharmacists’ roles in care optimization for Schizophrenic patients.
1.6 Research Questions
- What is the perception of schizophrenic patients regarding pharmacists’ roles in care optimization?
- What is the perception of other health care professionals regarding the roles of pharmacists in care optimization for Schizophrenic patients?
- What is the extent to which Pharmacists are involved in care optimization for Schizophrenic patients?
1.7 Research Hypothesis
- Socio demographic factors of Schizophrenic patients have no effects on their perception of pharmacists’ roles in care optimization [Relates to objective 2] .
THE ROLES OF PHARMACISTS IN CARE OPTIMIZATION FOR SCHIZOPHRENIC PATIENTS IN FEDERAL NEURO-PSYCHIATRIC HOSPITAL MAIDUGURI, NORTH-EASTERN NIGERIA
