Impact of clinical pharmacist interventions on clinical outcomes among patients with pulmonary tuberculosis: A pre-post multiple-arm analysis

Background: Despite implementation of national tuberculosis (TB) control programs, Pakistan is experiencing the quadruple burden of disease along with underlying resistance. Pharmacists’ interventions to improve disease outcomes have been promising. However, data on utility of pharmacist's involvement during the course of TB is limited. Current study was aimed to assess the impact of pharmacist interventions in order to enhance knowledge about disease, to improve treatment adherence and to identify and minimize side effects to therapy. Methods and materials: A Prospective interventional study was conducted among new treatment cases of TB attending Allama Iqbal memorial teaching hospital Sialkot, Pakistan from August 2018 to April 2019. Participants were divided in two groups i.e. intervention (n = 76) and control (n = 73) group. Medication adherence was assessed by MGLS-4 questionnaire and pill count. A self-designed questionnaire was used to assess the knowledge of patients. Side effects were identified and managed by interventions. Sputum smear microscopy and measurement of body weight was performed. All data were collected at baseline, at each follow-up visit and at the endpoint of treatment. The primary study outcomes were knowledge and adherence scores, levels of adherence based upon pill count, sputum smear microscopy, weight gain and resolution of side effects. Results: Our analysis yielded significant differences in knowledge and adherence scores, weight variation, identification and resolution of side effects among both groups. The treatment cure rate was higher among Intervention group (96.1%) than control group (74%). Control group was observed with delayed time to sputum conversion (2.58 months) than intervention group (2.07 months). Conclusion: Clinical pharmacist interventions delivered as combination of counselling, dietary and lifestyle modifications has a significant impact on improved treatment and clinical outcomes.