The medication management review service and its effect on patient's asthma knowledge and adherence to their medications

Abstract

Background: Asthma continues to be major challenge, detrimental disease and threat to health and economies. Tremendous number of asthmatics suffer from uncontrolled asthma and fatal exacerbations, therefore emergent interventions are needed to identify the roots of this dilemma and increase patient's knowledge of their disease in order to improve their adherence. The medication management Review (MMR) service is an appropriate service that can improve knowledge and adherence of asthma patients. Aim: To evaluate the impact of MMR service on the knowledge of asthmatic patients and subsequently their adherence to therapy. Methods: This study followed a single-blinded randomized controlled clinical trial design, and was conducted over 15 months in outpatient clinics of public hospitals in Amman, Jordan, involving asthma patients. Patients diagnosed with asthma were recruited and randomized into intervention and control groups. The MMR service was conducted for each patient to assess patients' knowledge and adherence. Socio-demographic characteristics were obtained via prepared questionnaires and patients' medical records. Clinical data were collected by validated questionnaires. Intervention group patients were educated concerning knowledge of asthma and adherence to therapy. Control group patients did not receive the education. Both groups were reassessed at 3 to 4 months after baseline, and their knowledge and adherence were evaluated. Results: Patients with asthma (n = 152) were recruited, intervention (n=76) and control (n =76) groups showed lack in asthma knowledge; score mean at baseline was 5.28±1.654 for intervention, 5.53±1.47 for control, P-value= 0.327. Asthma knowledge at follow up score was 8.87±0.099 and 5.57±1.398 for intervention and control groups respectively, with significant difference between both groups (P-value<0.001). The majority of patients were poor adherent to therapy at baseline, due to various factors such as misperception regarding their disease, absence of asthma action plan, and cognitive and economic issues. Neither at base line nor at follow up patients follow asthma action plan, 100% of intervention and 90.8% of control didn't have asthma action plan, as well as patients' inability to afford medications. on the contrary other adherence parameters were improved significantly for intervention group at follow up, forgetfulness to take medication barrier adherence mean score 3.36±2.284 at baseline and 4.75±1.308 at follow up, P-value< 0.001, patients' perceptions toward their preventative medication score elevated from 3.87±2.282 to 4.83±1.482, P- value < 0.001, poor adherence due to side effects was overcome, adherence score enhanced from 3.68±2.282 to 4.22±1.943, P-value< 0.001. In contrast to intervention group, control group didn't show any improvement at follow up. Conclusion: The MMR service, which was employed by pharmacists for the first time in Jordan evidenced successful in identifying and resolving asthma patient's lack of knowledge and adherence. Thus, positive health outcome and better asthma control can result from the service.