Abstract
Aims: This study aimed to assess the effect of discharge counseling with SMS reminders on medication adherence in chronic disorders.
 Study Design: Prospective randomized open-label trial
 Place and Duration of Study: The study was conducted at the dispensing department of a secondary care referral charity hospital located in a small village. The study was conducted for a period of six months from October 2018 to April 2019.
 Methodology: Upon consent, a total of 364 patients were enrolled in this study and randomized into two groups viz., intervention group (n=182) and control group (n=182) respectively, with and without discharge counseling and SMS reminder on medication usage by the clinical pharmacist. The level of medication adherence was measured using a pill count and visual analog scale (VAS) methods at two follow-up visits includes baseline and final follow-up visit (gap of two months). A two-sample Wilcoxon rank‑sum (Mann–Whitney) was used to compare the statistical mean difference of medication adherence levels between two groups at each follow‑up visit.
 Results: The mean age of intervention and control groups were 57.1±8.55 and 58.5±8.53; most of the subjects were >60 years of age and were typically suffering from hypertension (30.2%) and diabetes (34.8%). Initially, at baseline, the values of medication adherence level (pill-count method) were closer in both intervention (82.4±7.3) and control group (81.35±6.4), whereas at follow up visits, the levels of the intervention group (93.2±6.0, 95.6±2.25) were significantly increased (p<0.0001) as compared to the control group (81.2±8.5, 80.6±8.1).
 Conclusion: Thus, the statistical significance infers that the clinical pharmacist-mediated discharge counseling with SMS reminders would increase medication adherence levels in chronic disorders.
Highlights
According to World Health Organization (WHO), ‘Medication adherence” is defined as the degree to which the person’s behavior resembles the agreed recommendations from a health care provider [1]
Focus on chronic disorders; many factors contributed to the increased morbidity and mortality
Due permission was sought from the medical director and chief pharmacist of the hospital and approved with Institutional Review Board with a registration number of Raghavendra Institute of Pharmaceutical Education and Research (RIPER)/IRB/2018/050
Summary
According to World Health Organization (WHO), ‘Medication adherence” is defined as the degree to which the person’s behavior resembles the agreed recommendations from a health care provider [1]. Adherence involves integrating the physician’s medical advice and the patient’s lifestyle, values, and preferences for care to achieve a better patient’s health [2,3]. Focus on chronic disorders; many factors contributed to the increased morbidity and mortality. Poor medication adherence is one of the critical factors that is associated with mortality, and it causes re-hospitalization and economic burden [4]. Several techniques have been introduced to solve this problem including, improvements to pillboxes and bottles, including manual and electronic reminder systems. Most of these techniques are costly and limit their use [6]
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