Systematic Pharmaceutical Educational Approach to Enhance Drug Adherence in Liver Transplant Recipients.
BACKGROUND
Drug adherence is one of the most important factors determining graft and patient survivals after liver transplantation. A systematic pharmaceutical educational approach has been implemented to improve adherence in immunosuppressive drugs therapy at Siriraj Hospital.


METHODS
This study was a single-center cross-sectional study of liver transplant patients who received pharmaceutical care from transplant pharmacists. The clinical pharmacy services, including medication review to emphasize patients' knowledge and awareness of immunosuppressive and general drug therapies with the use of various tools, were used to educate the patients. Drug-related problems (DRPs) and pre- and post-transplantation educational tests (divided into 3 parts: immunosuppressants [12 points], drug monitoring [6 points], and general drugs [2 points]) were analyzed.


RESULTS
From October 2012 to September 2014, a total of 50 liver transplant recipients (86 visits) were enrolled. After the systematic pharmaceutical educational program, the average total score of post-transplantation educational test improved from 3.48 to 13.30 (P < .001). Likewise, the mean scores of all 3 parts significantly increased (part I: 2.28 vs 8.18 [P < .001]; part II: 0.75 vs 3.63 (P < .001); and part III: 0.46 vs 1.50 [P < .001]). The incidences of major DRPs, nonadherence, and adverse drug reactions were 8%, 4%, and 2%, respectively.


CONCLUSIONS
A systematic pharmaceutical educational approach can significantly improve patients' knowledge and awareness concerning immunosuppressive drug usage.
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Asavakarn
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: yongyut.sir@mahidol.ac.th.
Y
Y
Sirivatanauksorn
Ambulatory Care Unit, Pharmacy Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
R
R
Promraj
Ambulatory Care Unit, Pharmacy Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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A
Ruenrom
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Limsrichamrern
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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P
Kositamongkol
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Mahawithitwong
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
C
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Tovikkai
Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
W
W
Dumronggittigule
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D003430:Cross-Sectional Studies; D016903:Drug Monitoring; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000209:etiology / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D010353:Patient Education as Topic / Q000379:methods*; D010593:Pharmaceutical Services; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus