Impact of providing psychiatry specialty pharmacist intervention on reducing drug-related problems among children with autism spectrum disorder related to disruptive behavioural symptoms: A prospective randomized open-label study.
OBJECTIVE
Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient's function and quality of life. Due to the complicated neurobiological aetiology of autism spectrum disorder (ASD), a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population. We evaluate the impact of providing specialty psychiatry (PS) pharmacist intervention in identifying and resolving drug-related problems (DRPs) among children with ASD associated with disruptive behaviours.


METHODS
An eight-week-long, prospective, randomized open-label study was conducted. Children between 2.5 and 12 years of age with ASD and showing disruptive behaviours were included. They were randomly assigned to an intervention or a control group. Patients in the intervention group received pharmacist interventions delivered by a PS pharmacist, while those in control group were cared by a hospital pharmacist. The primary outcome was the number of patients who resolved of at least one DRP by the end of the study. The secondary outcome was to compare the mean Aberrant Behavior Checklist-Irritability (ABC-I) scores between the two groups.


RESULTS
Twenty-five patients were randomly assigned to either an intervention or control group. At week 8, the total number of patients who resolved of at least one DRP was 13 (52%) in the intervention group and 4 (16%) in the control group, respectively (P=.016). Improper drug selection, medication non-adherence and subtherapeutic dosage were the most common DRPs. Mean ABC-I scores improved in the intervention group more than in the control group (9.8±5.6 vs 17.7±7.9; P<.001).


CONCLUSIONS
To the best of our knowledge, this is the first study which demonstrated that PS pharmacist intervention is an effective strategy to resolve DRPs in patient with ASD. The reduction in common DRPs mostly resulted from the PS pharmacist interventions, including selection of antipsychotic agent, adjustment of dosage based on ABC-I scores and provision of individualized drug counselling. Reducing DRPs led to the improvement of any disruptive behaviour. In addition, multidisciplinary team should develop drug therapy protocols to promote the role of pharmacists in this setting.
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
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http://orcid.org/0000-0003-4534-8046
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Wongpakaran
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
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Suansanae
Yuwaprasart Waithayopathum Child Psychiatric Hospital, Samutprakarn, Thailand.
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Tan-Khum
Yuwaprasart Waithayopathum Child Psychiatric Hospital, Samutprakarn, Thailand.
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Kraivichian
Yuwaprasart Waithayopathum Child Psychiatric Hospital, Samutprakarn, Thailand.
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Ongarjsakulman
Department of Pharmacology, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
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Suthisisang
D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000067877:Autism Spectrum Disorder / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003376:Counseling / Q000379:methods; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010348:Patient Care Team / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D000066553:Problem Behavior; D024382:Professional Role; D011446:Prospective Studies; D011570:Psychiatry; D011788:Quality of Life; D013038:Specialization
D014150:Antipsychotic Agents
autism spectrum disorders; child psychiatry; disruptive behavioural symptoms; drug-related problems; pharmaceutical care; pharmacist intervention; psychiatry pharmacist