Effectiveness of patient‐oriented education and medication management intervention in people with decompensated cirrhosis

Abstract

People with chronic disease often have poor comprehension of their disease and medications, which can negatively affect health outcomes. In a randomised‐controlled trial, we found that patients with decompensated cirrhosis who received a pharmacist‐led, patient‐oriented education and medication management intervention (n = 57) had greater knowledge of cirrhosis and key self‐care tasks compared with usual care (n = 59). Intervention patients also experienced improved quality of life. Dedicated resources are needed to support implementation of evidence‐based measures at local centres to improve outcomes.

Poor disease knowledge is associated with higher healthcare service use and costs among patients with cirrhosis: an exploratory study

“…In Hayward et al 's study, patients who received the education intervention also experienced improved quality of life [38]. In this study, quality of life was assessed using a cirrhosis-specific quality of life tool [40] and improvement of scores from baseline to follow up were seen among patients who received the intervention, whereas usual care patients did not improve [38]. Zhang et al showed that health education in a hospital setting in China improved patients' understanding of key aspects of cirrhosis and how to manage it, and that led to improved health-related quality of life [33].…”

“…In the abovementioned review [35], two RCTs which included health-related quality of life as an endpoint reported no statistical difference between the intervention and control groups [36,39]. In Hayward et al 's study, patients who received the education intervention also experienced improved quality of life [38]. In this study, quality of life was assessed using a cirrhosis-specific quality of life tool [40] and improvement of scores from baseline to follow up were seen among patients who received the intervention, whereas usual care patients did not improve [38].…”

“…One randomised-controlled trial (RCT) included in this review which included health service use as an endpoint reported that the rate of attendance for planned outpatient care (secondary end point) was higher in the intervention group compared to usual care, but no difference was seen in liver-related occupied bed days (primary end point) [36]. In Australia, Hayward et al 's RCT showed that multifaceted pharmacist-led medication and disease education for patients with decompensated cirrhosis improved not only patients' knowledge about cirrhosis but also significantly reduced unplanned hospital admissions [37,38].…”

Improving Medication‐Related Outcomes in Chronic Liver Disease

“…A small number of patient‐oriented interventions that mention a dedicated medication component have been conducted in people with cirrhosis (Table 3). ( 7,89‐94 ) Most involved implementation of new multidisciplinary “chronic disease management” models or “patient care management” programs to improve postdischarge care and prevent readmission. Three studies delivered face‐to‐face interventions ( 89,92,93 ) and two studies used modern technologies ( 90,91 ) to assist with remote management of medications and liver disease complications.…”

“…One randomized controlled trial evaluated the effectiveness of a pharmacist‐led patient‐oriented education and medication management intervention in ambulatory patients with decompensated cirrhosis. ( 7,94 ) At follow‐up, patients who received the intervention (n = 57) had greater knowledge of cirrhosis and key self‐care tasks compared to usual care (n = 59). ( 94 ) Intervention patients also experienced improved QoL ( 94 ) and had a 48% reduced incidence rate of unplanned admissions during the 12‐month follow‐up period, which coincided with a 68.9% resolution rate of high‐risk MRPs.…”