Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



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Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
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It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2009 | Month : February | Volume : 3 | Issue : 1 | Page : 1319 - 1325

Performance Of The Medication Counseling Center In Manipal Teaching Hospital: A Follow Up Study

ALAM K *, PALAIAN S **,MISHRA P ***,SAH AK****,UPADHYAY DK**,BHANDARI RB ******,

*M.Pharma,Lecturer,**M.Pharma,Asst.Prof.DeptofHospitalandClinicalPharmacy/Pharmacology,ManipalTeachingHospiatal/ManipalCollegeofMedicalSciences,***Assoc.Prof,DeptofPharmacology,ManipalCollegeofMedicalSciences.****B.Pharma,HospitalPharmacistDeptofHospitalandClinicalPharmacy ManipalTeachingHospital. *****M.Pharma Asst.Prof. ****** Hospital Pharmacist DeptofHospitalandClinical Pharmacy/Pharmacology,ManipalCollegeofMedicalSciences,Pokhara(Nepal)

Correspondence Address :
Kadir Alam M.Pharm,Lecturer, Dept of Hospital and Clinical Pharmacy/Pharmacology Manipal Teaching Hospital/ Manipal College of Medical Sciences, Pokhara, (Nepal). E mail: alamkad2050@yahoo.com Phone: 00977-61-526420

Abstract

Objective: Non-compliance to drug therapy is a common problem worldwide. Providing counseling to the patients regarding their medication is a better means to improve patient compliance. The present study evaluated the performance of the Medication counseling center in Manipal Teaching Hospital, Pokhara, Nepal.
Methods: The filled medication counseling documentation forms during the period of three years (September 2004 to September 2007) were analyzed. The data obtained were entered in a Microsoft Excel spread sheet and were analyzed.
Results: Altogether, 1105 patients were counseled (as per the Omnibus Budget Reconciliation Act -1990 guidelines) by the center from September 2004 till August 2007. Females comprised 51% of the patients who received counseling. Nearly half of the counseled patients were from the Department of Otorhinolaryngology. Nasal spray was the most commonly used counseling aid (44.48 %). A majority of patients were counseled regarding the dosage form of the medication (97.29%), the dosage regimen (96.38%), the description of the medicine (96.02%), the route of administration (95.84%), duration of therapy (90.41%) and storage conditions (80.45%). Nearly 6-10 minutes were spent while counseling one third of the patients. In general, patients with modified drug delivery system, such as the metered dose inhaler and dry powder inhalers, were counseled more frequently.
Conclusion: It can be concluded that the Medication counseling center in the Manipal Teaching Hospital plays an important role in educating the patients regarding safe and effective use of their medications.
Practice Implications: In resource limited countries like Nepal, pharmacists can provide counseling to the patients through medication counseling centers. This may in turn improve patient adherence, which is one of the common causes for therapeutic failures in countries like Nepal.

Keywords

Nepal, Non-compliance, Patient counseling

Introduction
Non-compliance to drug therapy is a common problem worldwide. The problem of non-compliance is documented even in developed countries. Evidence suggests that non-compliance can lead to adverse drug reactions (ADRs) (1) and therapeutic failures (2). There are several reasons for non-compliance. The most common reasons include ADRs due to medication, poor understanding of instructions, the cost of medications, frequent administration, etc(3),[ 4],[ 5]. Several strategies can be taken to improve patient compliance. One of the best means is the counseling of the patient by the pharmacists. Several studies have acknowledged that counseling by pharmacists can improve the patient’s understanding about medication and lifestyle modifications(6),(7) ,(8). Patient counseling is defined as providing medication related information orally or in written form to the patients or their representatives, on topics like direction of use, advice on side effects, precautions, storage, diet and life style modifications(9). The ultimate goal of counseling is to provide information directed at encouraging safe and appropriate use of medications, thereby enhancing therapeutic outcome[.10]. The concept of patient counseling is very new in South Asia. One study from the neighbouring country, India, evaluated the impact of counseling by pharmacists(11).

In Nepal, due to poor literacy rates, lower economy and various other reasons, there are inadequate resources for patients to get information about their medicine. Moreover, there are no patient information leaflets in the pharmaceutical products manufactured by the Nepalese companies. Even while dispensing the medication, the retail Pharmacists do not provide adequate information to the patients. Even the Doctors and Nurses do not spent adequate time in counseling the patients. Manipal Teaching Hospital (MTH) is the first hospital in Nepal to set up a Medication Counseling Center (MCC) in Nepal. The counseling is done as per the Omnibus Budget Reconciliation Act -1990 (OBRA-90)(12). The preliminary evaluation of the MCC after the initial six months of functioning, concluded that the medication counseling center can play a definite role in enhancing the patient’s understanding about the medications and the disease pattern, which in turn, may improve patient compliance(13). Successively, a number of initiatives have been carried out to improve drug use situations in MTH. A hospital drug and therapeutics committee (DTC) was formed, consisting of staff from the departments of the hospital and the clinical pharmacy, pharmacology, medicine, administration and other clinical departments. The DTC has undertaken a number of initiatives to improve the prescribing of medicines(14). Restricting the number of brands in the hospital pharmacy and creating a hospital drug list, were some of the initiatives carried out(15). The department of pharmacology runs a drug information and pharmacovigilance center (DIPC) in the teaching hospital. The DIPC also introduced a Continuing Pharmacy Education (CPE) program for the pharmacists working in the hospital. The CPE focused mainly on diseases like diabetes, hypertension, asthma etc, where the pharmacists need to know more while counseling the patients in the MCC(16). The impact of these initiatives on the functioning of the MCC was not studied. Hence, the present study was carried out.

The objectives of the present study were
1. To study the demographic details of the patients visiting the medication counseling center
2. To study the therapeutic category of the drugs about which the patients were counseled
3. To study the counseling and compliance aids used by the pharmacists during the counseling process
4. To study the content of counseling provided to the patients
5. To study the time spent by the pharmacists in counseling the patients

Material and Methods

Methods
The filled medication counseling forms (Table/Fig 1) during the period of three years (September 2004 to September 2007) were analyzed. The data obtained were entered in a Microsoft Excel spread sheet and analyzed as per the study objectives.


Results

Altogether, 1105 patients were counseled during the study period. Among these patients, a majority [51% (n=566)] were females. Among the total patients, [49.5 % (n=547
)] were married. The age distribution of the patients who received counseling is given below in the (Table/Fig 2).

The departments from where the patients came to the MCC were studied. The details are shown in (Table/Fig 3).

Most of the patients who visited the MCC were directed by the pharmacists (62.3%) and then by the doctors (12.9%). However, 7.2% of the patients visited, based on their own interest. The therapeutic classifications of the drugs counseled by the pharmacists in the MCC are given in (Table/Fig 4).

Most of the drugs about which counseling was given were of oral dosage form (48.1%), followed by inhalation medications (34.14%), topical agents (14.8%) and few (0.41%), which belonged to the parenteral dosage forms. The details of dosage form of the counseled drugs are shown in (Table/Fig 5).

The pharmacists used certain counseling aids while counseling the patients. The details regarding the use of counseling aids are given in (Table/Fig 6).

The pharmacists provided counseling to the patients directly in a private space. Sometimes the counseling was given to the patient parties as well. The details of the receivers of the counseling are given in (Table/Fig 7).

The various points covered while counseling the patients are studied. The details are given in (Table/Fig 8).

While counseling, the pharmacists used ‘compliance aids’ in order to improve the compliance following the counseling. The most commonly provided compliance aids were ‘medication envelops’ (52%), followed by ‘medication calendar’ (0.63 %) and Leaflets (0.09%). However, in 44.71% of the cases, compliance aids were not used. The amount of time spent by the pharmacists to counsel the patients is given in (Table/Fig 9).

The majority of times counseling was given by the ‘pharmacy assistant’ and then by the ‘pharmacist’. The details are given in (Table/Fig 10).

Discussion

The present study evaluated the performance of the MCC in MTH. Most of the patients visiting the MCC were from the Department of Otorhinolaryngology. This is because a considerable number of patients were prescribed with nasal sprays. In general, patients with nasal sprays required counseling regarding the use of the device. However, the previous study identified placebo MDIs to be the most commonly used counseling aids(13). This finding suggests that many patients who initially received counseling for the MDIs did not need counseling during their follow-up visits. We found hormone and hormone antagonists to be the most commonly counseled class of drugs. This is because these patients were prescribed with corticosteroids to be inhaled, which required counseling.

For better counseling, the pharmacists used ‘counseling aids’. Counseling aids are one of the better means to improve counseling (Appendix 2) Refer: (Table/Fig 1). The most commonly used counseling aids were nasal sprays, metered dose inhalers (MDI) and rotahalers (a form of dry powder inhaler). Counseling patients with MDI is very essential. It has been shown that approximately 75% of the patients using MDIs do not take them properly[ 17].

In cases such as paediatric patients, elderly etc, the pharmacists counseled the patient party. It was understood that it was better to counsel the patient attendants of these patient population, so as to have a better compliance.

In MCC, counseling is provided as per the OBRA recommendations. As per the OBRA recommendations(12), the pharmacist must provide certain information to the patients while dispensing medication in the US. In Nepal, recently the good pharmacy practice (GPP) guidelines has been drafted, which also provides certain guidelines for the pharmacist to counsel the patients(18).

Dedicating adequate time is an important factor while counseling the patients. In our study, the pharmacists spent 6-10 minutes for more than one third of the patients, which is a welcoming effort. Dedicating more time will certainly have a positive impact on counseling.

In order to improve the outcome of the counseling, the pharmacists used ‘compliance aids’ that include medication envelops, medication calendar and leaflets. The use of leaflets and medication calendar were very poor, and needs to be improved. The use of medication envelops is one of the better means while counseling the illiterate patients.

Conclusion

The present study was successful in identifying the performance of the Medication counseling in MTH. Patients from the Otorhinolaryngology were the ones visiting the MCC more often. In general, the patients with modified drug delivery systems such as the MDIs and dry powder inhalers were counseled more frequently. The time spent by the pharmacists is adequate and in some cases, the patient parties were counseled for better outcomes. It can be concluded that, MCC at MTH plays an important role in educating patients towards safe and effective use of medicines.

Practice Implications
In resource limited countries like Nepal, pharmacists can provide counseling to the patients through medication counseling centers. This may in turn improve patient adherence, which is one of the common causes for therapeutic failures in countries like Nepal.

References

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. Einarson TR. Drug-related hospital admissions. Ann Pharmacother 1993; 27: 832-40
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. McKenney JM, Harrison WL. Drug-related hospital admissions. Am J Hosp Pharm 1976; 33: 792-95
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. Anupa K C, Durga B, Subish P, Mishra P. Patient counseling by pharmacists- a novel approach to enhance patient compliance. J Nep Pharm Assoc 2005; 23:17-22.
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. Ramesh A. Patient Counseling. In Proceedings: National seminar on advances in industrial pharmacy and pharmacy practice 1999, 17th-18th Oct. JSS College of pharmacy, Mysore, India
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. Buabeng OK, Matowe L, Plange- Rhule J. Unaffordable drug prices: the major cause of non-compliance with hypertension medication in Ghana. J Pharm Pharmaceut Sci 2004; 7(3):350-2
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. Jaber LA, Halapy H, Fernet M, Tummalapalli S, Dewakran H. Evalaution of pharmaceutical care model on diabetes management. Ann Pharmacother. 1996; 30: 238-2.
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. Sczupak CA, Conrad WF. Relationship between patient-oriented pharmaceutical services and therapeutic outcomes of ambulatory patients with diabetes mellitus. Am J Hosp Pharm 1977. 34:1238-42
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. Palaian S, Acharya LD, Rao PGM, Shankar PR, Nair NM, Nair NP. Evaluation of the impact of patient counseling in terms of knowledge, attitude and practice outcomes of hospitalized diabetic patients. P and T journal 2006; 31 (7): 383-400.
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. USP medication counseling behaviour guideline. USP DI update volumes I and II Rockville, the United States Pharmacopeia s

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