Pharmacotherapy Patient Counselling: Another feather in the cap
for Clinical Pharmacology discipline in a resource-limited setting
The clinical Pharmacology discipline came into existence in India 50
years back.1 The scope of clinical Pharmacology is
continuously expanding round the globe. There is a parallel rise in
patient-oriented services such as Evidence-based medicine on-call
service- an advanced version of the drug information center (DIC)
service along with many more other services.2 Few of
these services are routinely taken up as a part of the DM(Doctor of
medicine) clinical pharmacology curriculum in India to train resident
doctors. The current curriculum of the super specialization DM clinical
Pharmacology in India is not uniform throughout the country and varies
as per the resources available.1 In the western side
of the globe, the hospital pharmacists and clinical pharmacists are
actively helping patients with drug therapy related counseling over and
above clinicians offering an ample amount of time for a thorough
discussion over disease prognosis and treatment courses. Indian scenario
is almost opposite to that of the western one due to several reasons.
Disproportionate doctor-patient ratio, daily wages lost in waiting for
consultation in public hospitals, scanty amount of time spent per
patient consultation, absence of dedicated clinical pharmacist
designation, are some of the major hurdles in providing quality
pharmacotherapy with proper counseling in the
country.3 Thus, there is a call for the novel clinical
pharmacology service via which one can bridge this gap and help the
local population with relevant counseling related to the treatment plan
and tailor it towards patient-specific concerns.4
Authors hypothesized that difficult counseling scenarios such as drugs
to be avoided in mastocytosis patients, myasthenia gravis, long QT
syndrome, porphyria patients, could be the arena to explore for
pharmacology and clinical pharmacology departments in developing
countries. With this background idea, the DIC started patient counseling
sessions for the five diseases (Figure 1). The clinician colleagues were
approached with a pre-designed message via the central mobile SMS
service of our institution. The text message included - “For any
pharmacotherapy counseling please send your patients to the drug
information center, Department of Pharmacology. The patient will be
guided regarding drugs to be avoided and how to stratify the risk
associated with drugs (prescription and over the counter) used in the
following five disorders- G6PD(glucose-6-phosphate dehydrogenase)
deficiency, Long QT syndrome, Mastocytosis, Myasthenia gravis, and
Porphyria”. The DIC received 97 patients in six
months(August2019-January2020). The patients were requested for feedback
post counseling session on a questionnaire with eight multiple choice
questions(supplementary file table 1). Institutional ethics committee
permission was obtained before initiation of pilot run service. Ninety
one(93.8%) were satisfied with the length and discussion whereas six
patients (6.18%) were not. Efforts were taken to identify etiology for
the unsatisfactory response. Three patients reported long waiting time
was the reason. On further questioning whether they received counseling
in a suitable time of day or not, two patients reported that they
received drug therapy counseling within a suitable time while one
patient didn’t agree. Fisher’s exact test showed no statistically
significant difference between the satisfaction rating versus a suitable
or unsuitable time frame of counseling. Fisher’s exact value was 0.5 and
a non-significant result at p-value 0.05. Another attempt was made to
check the association of the educational status of patients and the
overall rating. Out of total 97 patients, 23 were postgraduate, 30 were
graduate, 42 had completed schooling and two had not. One unsatisfactory
response was received from postgraduate and graduate patients each.
Fisher exact test applied on educational status versus satisfaction
rating showed a non-significant difference at p-value 0.05 with Fisher
exact value of one. Efforts were also made to check whether the resident
on duty was able to communicate and answer the queries raised by the
patients satisfactorily. One patient (1.03%) giving an unsatisfactory
rating said that patient’s queries were resolved appropriately but
beyond a suitable time frame. A similar study conducted by our group on
doctor’s feedback previously showed that more than 98% of clinicians
found the service satisfactory. There was no significant association
between the clinician’s academic experience and the satisfaction rating.
Over and above more than 96% of clinicians followed the pharmacotherapy
advice recommended by DIC in their patient
management.5