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DIABETIC PATIENT MANAGEMENT AT KENYATTA NATIONAL HOSPITAL: A PHARMACIST’S ROLE. BY: FARWA MOLOO U29/35723/2010 SUPERVISOR: DR AMUGUNE. INTRODUCTION. Diabetes growing epidemic threatening to overwhelm health services and undermine economies, especially in the developing countries( WHO, 2008).
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DIABETIC PATIENT MANAGEMENT AT KENYATTA NATIONAL HOSPITAL: A PHARMACIST’S ROLE BY: FARWA MOLOO U29/35723/2010 SUPERVISOR: DR AMUGUNE
INTRODUCTION • Diabetes growing epidemic threatening to overwhelm health services and undermine economies, especially in the developing countries( WHO, 2008). • Diabetes is a chronic disorder characterized either by: • inability of the pancreas to synthesize and secrete insulin • or properly utilize insulin resulting in chronic hyperglycemia.
……. • If diabetes is not managed appropriately, complications can arise including: • Skin infections • Glaucoma • Cataracts • Diabetic foot • Diabetic ketoacidosis • Gastroparesis • Hypertension • Diabetic Neuropathy • Stroke
INTRODUCTION… • To achieve optimum control of condition important consideration on: • Compliance to pharmacological management • Compliance to non pharmacological management • Laboratory support: glucose , lipid and glycated hemoglobin level measurements. A pharmacist’s role crucial
STUDY RATIONALE • Studies show most health care workers in developing countries aim only to provide the patients with medications but without appropriate information on: • lifestyle, • medications side effects • importance of medication compliance. • a pharmacist can reduce prevalence by having an appropriate pharmaceutical plan for medication related problems
STUDY OBJECTIVES • Overall objective To evaluate the management of diabetic patients at the out- patient diabetic clinic in Kenyatta national hospital • Specific objectives • To assess diabetic patients compliance to their anti-diabetic medications. • To determine the factors that lead to non compliance to anti- diabetic therapy. • To explore the various approaches that may be adapted by a pharmacist to reduce non compliance. • To determine the non- pharmacological support services provided as part of the diabetes management plan.
METHODOLOGY Study design: a mixture of: • retrospective-patients’ files were perused, • Prospective-participants interviewed using a questionnaire. Study Site: KNH outpatient diabetic clinic Study population: Patients mainly resided within Nairobi. Sample size: 140 Informed and consented diabetic patients participated. Study approval: KNH- UON ERC
RESULTS AND DISCUSSION • 70 % of the patients were type 2 diabetics that lay in 51 to 60 years age range
RESULTS AND DISCUSSION… • Most patients adhered to their medications but did not adhere to strict diet and exercise regimes. • 67% of the patients were obese and 60 % were on blood pressure medications.
RESULTS AND DISCUSSION… • Some type two obese patients reported not attending regular counseling sessions and experienced problems such as: • Visual disturbances • Numbness/ burning sensation on the foot • High cholesterol • Kidney problems • Amputation of the toe
RESULTS AND DISCUSSION… • Type one diabetics reported challenges in: • Measuring insulin dose • Cost of the insulin • Forgetting to inject at the right time. • Patients checked their blood sugar often and • could detect when they were hypoglycemic from the symptoms they experienced • However, detection of the hyperglycemic state seemed to pose a problem in 31 % of the patients.
RESULTS AND DISCUSSION… • Patients • Were familiar with the ideal meal plan for a diabetic • exercised daily but the intensity of exercise was reported to be easy.
RESULTS AND DISCUSSION… • Alcohol and tobacco consumption was not observed as a problem amongst participants. • 33 % were on insulin, 36 % t on tablets and the rest were on combination therapy (insulin and tablets).
RESULTS AND DISCUSSION… Low compliance observed 10 % of the participants due to: • Cost of the medications • Lack of drug information • Ignorance • Forgetfulness in the old aged • Irregularities in attending diabetic clinics • Pill burden • Side effects of medicines • Difficulty in measuring the dose of insulin • Difficulty in adhering to time due to work constraints
RESULTS AND DISCUSSION… • 41% percent of patients had been sent for HbA1C • BP, weight and blood glucose were checked at every visit • Patients regularity of getting cholesterol, urine and eye tests depended on if they could afford it.
RESULTS AND DISCUSSION… • There was no pharmacist at the diabetic clinic • Patients bought their medications from a separate pharmacy. • Aim at the pharmacy was to clear the long queue rather then counsel patients.
CONCLUSION AND RECOMMENDATIONS • There is a correlation between non compliance to pharmacological & non pharmacological management of diabetes and development of complications. • A pharmacist should be incorporated in the medical team at the diabetic clinic in order to reduce non compliance in patients.
RECOMMENDATIONS Role of the pharmacist be : • Choosing medications that require less frequent administration with few or no side effects • Counseling patients on expected side effects and how to minimize them • Educating patients to keep diaries/set reminders • Counseling patients on consequences of non compliance and regular follow up • In the assessment, identification, education, referral and monitoring of the condition.
