Effects of caregiver counselling on medication persistence and adherence in patients with dementia at a pharmacist‐managed clinic: A pilot study

Abstract

What Is Known and Objective Low treatment persistence and adherence in patients with dementia results in a rapid loss of disease control. This pilot study evaluated the impact of pharmacist‐provided caregiver counselling on treatment persistence, adherence, quality of life (QoL) in patients with dementia, as well as caregiver's knowledge of dementia, and caregiver burden. Methods This prospective, randomized controlled study was performed at a hospital‐based pharmacist‐managed clinic from December 2017 to December 2019. Patients with mild‐to‐moderate Alzheimer's disease (AD), initiating cholinesterase inhibitors within 3 months, and coming with their caregivers were included and randomized 1:1 to intervention or control group. The intervention group received pharmacist counselling and education sheets about AD, whereas the control group only received standard of care. Patients' treatment persistence and adherence were assessed at months 3, 6, 9, and 12; QoL, and caregiver burden were assessed at baseline and month 12. Caregiver's knowledge of dementia was assessed at baseline and 2 weeks after counselling in the intervention group. Nonparametric statistics and generalized estimating equation models were used for statistical analysis. Results and Discussion A total of 40 patients and 40 caregivers were included, with 20 pairs for each group. One‐year medication persistence (16/20 vs. 16/20) and adherence rates (87%–99%) were high in both groups without significant differences. Dementia knowledge scores improved significantly after counselling in the intervention group (77.5 vs. 95.8, p < 0.01). Although the change of caregiver burden was non‐significant between groups, the score decreased in the intervention group (−0.89; p = 0.78) but increased in the control group (+6.01; p = 0.07). What Is New and Conclusion In this pilot study, pharmacist's counselling for patients with dementia and their caregivers is feasible and can enhance caregiver knowledge of dementia. Further study with larger scale is needed to confirm the impact on these outcomes.

Patterns in counselling services provided at Saudi Ministry of Health medication counselling clinics – Reasons for referrals and subjects discussed: A cross-sectional study

“…This is in line with the previous study, which concluded that delivery via a caregiver was a major counselling barrier ( Albekairy, 2014 ). It is also in line with the findings of a recent study in Taiwan about the effect of caregiver counselling on medication persistence and adherence, which found no significant effect of caregiver intervention on treatment outcomes ( Huang et al, 2020 ).…”

Alzheimer’s Disease—Biochemical and Psychological Background for Diagnosis and Treatment

“…Screaming and wailing is reported in 25% of AD patients, while aggressiveness violence is observed in 20% of patients with AD. The behavioral and mood disturba afflicting patients with AD are a major source of primary caregiver burden and an portant contributor to the decision to admit AD patients to institutionalized care [4,5] prevalence and severity of these disturbances are patient-specific [6]. Reported differe arise from the degree and location of brain damage, premorbid personality, the env ment and relationships with other people (Figure 2).…”

“…Another psychologically interesting aspect of AD is the fact that symptoms and the rate at which they develop can be related to an individual's emotional response to the disease and the response of the patient's immediate environment, including significant people providing home care or institutional care and who are vulnerable to emotional burnout as a consequence [25,26]. A number of researchers indicate that AD symptoms, which can be described as heterogeneous and fluctuating, are influenced by the environment or aggravated by emotions expressed by the caregivers [4]. Therefore, psychological support 6 of 10 for caregivers becomes a challenge for the health and prevention policy implemented in Poland and beyond.…”

Perspectivas atuais da doença de Alzheimer: aspectos patogênicos e terapêuticos

“…Na maioria dos casos de DA, são observados sintomas comportamentais e de humor, cuja prevalência é relatada da seguinte forma: 75% dos pacientes demonstram comportamento perturbador, associado à agitação; aproximadamente 60% exibem comportamento errante; e cerca de metade dos pacientes, apresentam sintomas depressivos, tais como anedonia, disforia, sentimentos de culpa, diminuição do apetite, perda de peso e dificuldade de concentração, além de uma propensão a vocalizações elevadas e ocorrência de sintomas psicóticos, como alucinações, delírios e paranoia. Manifestações de gritos e lamentos são mencionadas em aproximadamente 25% dos pacientes acometidos pela DA, ao passo que comportamentos agressivos e violentos são observados em cerca de 20% dos casos de DA (Huang et al, 2022).…”