(I) Impact of Clinical Pharmacist Interventions on Patients' Quality of Life (QoL) and Influencing Risk Factors Associated with Poor QoL in Systemic Lupus Erythematosus Disorder Patients

Publication Number: 299

Background: High disease activity and presented multi-comorbidities reduce patients’ quality of life (QOL) in patients with systemic lupus erythematosus (SLE). The data of the impact of clinical pharmacist interventions in patients’ quality of life (QoL) among SLE patients is still unknown.

Objectives: To determine the impact of clinical pharmacist interventions on the patients' quality of life and influencing risk factors associated with poor patients’ QoL among systemic lupus erythematosus patients.

Methods: A prospective cohort study was conducted at the rheumatology department in a tertiary care teaching hospital for twenty-two months. Patients of either gender and aged ≥ 16 years diagnosed with SLE and admitted to hospital or visited the outpatient department were randomised either into the usual care group (UCG) and multidisciplinary care team (MDCT). Patients in MDCT received rheumatologist and clinical pharmacist care, whereas, patients in UCG received only rheumatologist care for 6 months. Pharmacist care included pharmacist education sessions, providing validated patient information leaflets (PIL) and 10-20 minutes patient counseling sessions in each visit. Patients’ QoL was assessed at the baseline visit, 3 months and 6 months using the World Health Organization Quality of Life Instrument (WHOQOL-BREF) questionnaires in both group. Binary logistic regression analysis was used to assess the risk factors influencing poor QoL. All statistical analysis was carried out through SPSS V25. P-value < 0.05 at 95% confidence interval (CI) was considered as statistical significant.

Results: A total of 202 SLE patients were enrolled in this study and 192 patients [UCG: 93 patients and MDCT: 99 patients] completed the final follow-ups. The patient’s QoL based on WHOQOL-BRIEF score [Overall (mean±SD): 25.82 ± 9.45; UCG (mean±SD): 26.40 ± 9.98 and MDCT (mean±SD): 25.25 ± 9.91] found poor in both groups. At 6 months of follow-ups, patients’ QoL in MDCT [Baseline vs end of follow-up: 25.25 ± 9.91 vs 50.28 ± 12.34, P< 0.001] was significantly improved and was high compared to the UCG [Baseline vs end of follow-up: 26.40 ± 9.98 vs 30.44 ± 09.61, P=0.08]. High improvement was abosrved in psychological domain [Baseline vs end of follow-up: 23.12±7.21 vs 58.28± 11.42, p< 0.0001] in MDCT and was high compared to the UCG. In regression analysis, uneducated status, comorbidities, stress and treatment adherence were identifed as highly significant risk factors that asscoaited with poor QOL in SLE (p < 0.0001).

Conclusions: This study reveals that the QoL in SLE patient is poor. Clinical pharmacists’ interventions can help to improve patients’ QoL in SLE patients. Uneducated status, comorbidities, stress and treatment adherence most common influencing factors for poor QoL.