Pharmacists can play a key role in providing patient education and alleviating any concerns around treatment regimens , thereby empowering and encouraging patients to engage and take responsibility for their care
Katie Yeung PGDip MPharm IPresc Niraj Chudasama PGDip MPharm IPresc St Mark ’ s Hospital , London North West University Healthcare NHS Trust , UK
The management of chronic disease has presented a significant challenge for healthcare systems in the UK and Europe . While the primary focus has been on addressing acute issues and reducing waiting times , there is a growing demand for comprehensive care for chronic illnesses , including autoimmune conditions . 1 Managing these long-term conditions effectively can lead to substantial cost savings and better patient outcomes . 1
Autoimmune diseases are complex , unpredictable , and prone to relapse . This can lead to recurrent hospital visits , frustration , anxiety , depression , and poor treatment adherence , ultimately resulting in poor patient and clinical outcomes . 1 , 2 It can create a never-ending cycle , where the lack of patient education and compliance with therapy leads to further hospital admissions and more complex treatment regimens . This , in turn , reduces adherence , and the associated physiological and mental stress may worsen the disease state and quality of life . Therefore , it is essential to develop and implement educational strategies that improve treatment adherence to achieve better outcomes and improve overall quality of life . 2
Treatment plans for autoimmune conditions are designed to alleviate symptoms , prevent disease progression , and improve patients ’ quality of life . However , achieving these goals can be difficult if patients fail to comply with their treatment regimen . 2 Improving patient compliance is therefore crucial for achieving better patient outcomes . To this end , efforts should be focused on enhancing patient education , which can facilitate better adherence to treatment plans . 3 Patients and clinicians often have different concerns , leading to disparities in treatment goals . Pharmacists can play a critical role in bridging this gap by providing patient education and alleviating any concerns about the treatment regimen . Empowering patients , encouraging them to engage , and take responsibility for their care can have a profound effect . 3 , 4
Role of the pharmacist : education and interventions The management of autoimmune conditions can be extremely complex . Intensive and complex drug treatment are often required as part of the management plan . As a result , many patients are unable to achieve the desired effect and reach remission due to various reasons , some of which include medication failure , drug intolerance , adverse drug reactions , non-adherence to medication and lack of understanding to disease and medication . Given these issues , this increases the need for pharmacist intervention in managing autoimmune disorders by delivering individualised pharmaceutical care , particularly with the current emphasis on medication optimisation ( MO ). 5 , 6
MO is a person-centred approach that involves shared decision-making between the clinician and the patient . Focus is placed on the patients ’ beliefs and experiences to make fully informed choices that reflect what is important to them . Therefore , effective communication between clinician and patient is needed for supporting adherence and improving outcomes . Pharmacists are well placed to make this happen especially now that there are increasing specialist roles within secondary care , including pharmacist-led clinics with heavy emphasis in the counselling of new medication , as well as review of ongoing treatment and disease progression . 6 , 7
Patient education leads to compliance Through individualised pharmaceutical care plans , pharmacists can improve patient adherence to medication by improving patient understanding of their disease , consequences of uncontrolled inflammation , the mechanism of action of the medication , as well as providing evidencebased information on clinical effectiveness so that patients can be given reassurance and confidence before starting treatment . Setting out a realistic time frame of therapeutic effect can help patients manage their expectations and reduces the chance of them discontinuing treatment early on . 6 , 7
Clinical pharmacists also play an essential role in the early identification and resolution of drug-related problems ( DRPs ) and are capable of suggesting appropriate alternatives to optimise therapy . Routinely used medications such as diseasemodifying anti-rheumatic drugs ( DMARDs ) have a range of DRPs , and studies have shown that participation of pharmacists in the management of DRPs has a significant impact in resolving them . 8 In one study , the majority of reported DRPs were associated with polypharmacy and the use of complex regimes owing to the presence of multiple comorbidities in systemic autoimmune disorder . Other factors that contributed to DRPs were patient-related ( n = 326 , 24.5 %). This indicated that a patient ’ s involvement in drug selection and adequate awareness about appropriateness of therapy use is important . These results highlight the importance of a multi-disciplinary approach involving the patients along with the prescriber and pharmacist during drug selection to minimise patient-related DRPs . 8 The study also reviewed interventions made by pharmacists and results showed high acceptance rate ( 93.6 %) which led to 90.4 % resolution of the DRPs . 8 Thus pharmacist intervention can greatly help in the
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