The Effectiveness of Pharmacotherapeutic Services in Enhancing Tuberculosis Treatment Adherence in Primary Care

Apikoglu Cavalcanti^*
*Correspondence: Apikoglu Cavalcanti, Department of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, MG, Brazil, Email:

Introduction

Tuberculosis (TB) remains one of the deadliest infectious diseases worldwide, with millions of new cases and significant morbidity and mortality annually. Despite the availability of effective pharmacotherapy, TB continues to cause substantial health burden, especially in low- and middle-income countries. Treatment adherence is a critical factor in ensuring successful outcomes in TB treatment, as non-adherence can result in treatment failure, drug resistance and the spread of the disease. Pharmacotherapeutic services, which include medication management, patient education and monitoring, have been identified as crucial interventions to improve treatment adherence. In primary care settings, these services play an essential role in managing patients' therapeutic regimens, providing ongoing support and addressing barriers that may affect adherence [1].

Tuberculosis treatment involves a lengthy course of multiple antibiotics, typically spanning six months. This extended treatment duration, along with the side effects of medications, poses significant challenges to adherence. Non-adherence to tuberculosis treatment has been linked to various negative outcomes, including treatment failure, relapse and the emergence of Multi- Drug-Resistant Tuberculosis (MDR-TB). Studies show that non-adherence rates can be as high as 30% in some settings, leading to poor treatment outcomes and increased transmission of TB. Several factors contribute to poor adherence to TB treatment. These factors can be broadly categorized into patient-related, treatment-related and healthcare system-related barriers. Patient-related factors include forgetfulness, lack of understanding of the importance of completing the full course of treatment and the side effects of medications. Treatment-related factors include the complexity of the TB regimen, the length of the treatment and the pill burden. Healthcare systemrelated factors, such as limited access to healthcare services, long wait times and lack of continuity in care, can further complicate adherence [2].

Description

Pharmacotherapeutic services are specifically designed to address these challenges and support patients throughout their treatment journey. These services aim to ensure that patients understand their treatment regimen, overcome barriers to adherence and receive the necessary support to achieve successful outcomes. Pharmacotherapeutic services encompass a range of activities designed to optimize the use of medications and improve patient outcomes. In the context of tuberculosis treatment, pharmacotherapeutic services play a pivotal role in enhancing adherence by providing personalized care and support. The foundation of pharmacotherapeutic services is the provision of comprehensive medication management. Pharmacists and primary care providers review the TB treatment regimen, ensuring that the prescribed medications are appropriate, the correct doses are being taken and potential drug interactions or side effects are minimized. Given the complexity of TB regimens, medication management includes counseling patients on the proper use of drugs, the importance of taking them as prescribed and how to manage side effects. This helps to improve adherence by reducing confusion or anxiety related to medication use [3].

Education is a critical aspect of pharmacotherapeutic services. Patients must understand the importance of completing the full course of TB treatment to prevent relapse and drug resistance. Education provided by healthcare professionals, including pharmacists, nurses and physicians, helps patients recognize the signs and symptoms of TB, understand the necessity of adherence and learn how to manage side effects. Additionally, educating patients about the risks of non-adherence, such as the development of MDR-TB, helps motivate them to stay committed to the treatment regimen. Regular monitoring and follow-up are essential to ensure that patients are adhering to their treatment plan and that any issues are identified early. Pharmacotherapeutic services include routine checks for side effects, assessment of patient progress and providing solutions to any challenges that arise. These services may include pill counts, directly observed therapy (DOT) and lab testing to track treatment response and detect any adverse effects. Regular follow-up visits also help identify any gaps in adherence, allowing healthcare providers to intervene before non-adherence leads to treatment failure. Pharmacists and other healthcare providers are trained to identify barriers to adherence, whether they be physical, psychological, or social. These barriers may include financial constraints, transportation issues, stigma, or mental health conditions such as depression.

Pharmacists, in particular, are well-positioned to provide solutions to overcome these obstacles. For example, they can help patients manage the cost of medications, provide strategies for remembering to take medications, or suggest ways to improve access to healthcare services. By addressing these barriers, pharmacotherapeutic services can significantly improve the likelihood of treatment completion.Effective tuberculosis treatment often requires a team approach, with input from physicians, nurses, pharmacists, social workers and other healthcare professionals. Pharmacists, in particular, collaborate closely with physicians to ensure that patients receive the most appropriate medications and that any drug interactions or side effects are managed effectively. This collaborative approach allows for holistic care that addresses all aspects of the patient's health, increasing the likelihood of successful treatment adherence [4].

Numerous studies have highlighted the positive impact of pharmacotherapeutic services on TB treatment adherence in primary care settings. For example, a study conducted in India found that patients who received pharmacotherapeutic support, including medication counseling and follow-up visits, had significantly higher adherence rates than those who did not receive such services. The study concluded that pharmacotherapeutic interventions could play a crucial role in improving treatment adherence and reducing the incidence of MDR-TB. Similarly, a randomized controlled trial in Kenya demonstrated that patients who received directly observed therapy with the involvement of pharmacists had higher treatment completion rates compared to those who received standard care. The study suggested that the personalized care provided by pharmacists helped ensure that patients adhered to their treatment regimen and that any issues, such as side effects or medication interactions, were addressed promptly. A meta-analysis of TB treatment adherence interventions also found that pharmacotherapeutic services, including education, monitoring and personalized medication management, were associated with a significant reduction in treatment failure rates. The analysis concluded that pharmacist-led interventions were particularly effective in low-resource settings where access to healthcare is limited, as they help bridge the gap in care and provide continuous support to patients [5].

Conclusion

The effectiveness of pharmacotherapeutic services in enhancing tuberculosis treatment adherence in primary care is evident from numerous studies and real-world implementations. By focusing on medication management, patient education, regular monitoring and addressing barriers to adherence, pharmacotherapeutic interventions significantly improve treatment outcomes and reduce the risk of drug resistance and TB transmission. However, challenges such as resource limitations, integration into healthcare systems, patient stigma and lack of motivation must be addressed to optimize the impact of these services. As the global burden of tuberculosis remains high, expanding and strengthening pharmacotherapeutic services in primary care settings will be crucial to achieving better treatment outcomes and ultimately eliminating tuberculosis as a public health threat. By investing in these services, healthcare systems can provide more comprehensive, patientcentered care that fosters adherence, reduces the burden of disease and ensures the success of tuberculosis treatment worldwide.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

References

1. Clark, Philip M., Turan Karagoz, Sule Apikoglu-Rabus and Fikret Vehbi Izzettin. "Effect of pharmacist-led patient education on adherence to tuberculosis treatment." Am J Health-Syst Pharm 64 (2007): 497-505.

   Google Scholar, Crossref, Indexed at

2. Tang, Zhao‐Qi, Rui‐Hua Jiang and Hong‐Bin Xu. "Effectiveness of pharmaceutical care on treatment outcomes for patients with first‐time pulmonary tuberculosis in China." J Clin Pharm Ther 43 (2018): 888-894.

   Google Scholar, Crossref, Indexed at

3. Curran, Geoffrey M., Mark Bauer, Brian Mittman and Jeffrey M. Pyne, et al. "Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact." Med Care 50 (2012): 217-226.

   Google Scholar, Crossref, Indexed at

4. Pinnock, Hilary, Melanie Barwick, Christopher R. Carpenter and Sandra Eldridge, et al. "Standards for reporting implementation studies (StaRI) statement." BMJ 356 (2017).

   Google Scholar, Crossref, Indexed at

5. Abrogoua, Danho Pascal, Boua Alexis Thierry Kamenan, Brou Jean Marcel Ahui and Elisée Doffou. "Pharmaceutical interventions in the management of tuberculosis in a pneumophtisiology department, Ivory Coast." Ther Clin Risk Manag (2016): 1749-1756.

   Google Scholar, Crossref, Indexed at