Investigator(s)
| Submitter |
Lalita Powdel Naresuan University Lalita Powdel 
|
| Principal Investigator |
Lalita Powdel Naresuan University Lalita Powdel
|
| Co-Investigator(s) |
Dr.Athagran Nakham Naresuan University Dr.Athagran Nakham
|
Title(s) and abstract
| Scientific title | Impact of Pharmacist-led intervention in assessment of medication adherence and clinical outcomes among patients on oral hypertensive therapy with comorbidities in Bhutan. |
| Public title | Impact of Pharmacist-led intervention in assessment of medication adherence and clinical outcomes among patients on oral hypertensive therapy with comorbidities in Bhutan. |
| Background | Non-communicable disease (NCD) is a global issue, causing a huge number of deaths every year(WHO, 2025b). According to the World Health Organization, in 2019, 74% of worldwide deaths were due to chronic diseases, which increased to 75% in 2021(Farhana et al., 2025). Hypertension is a major risk factor for cardiovascular diseases (CVD) and is one of the common health problems in low and middle-income countries (Malik et al., 2021). Among adults with hypertension, approximately half are unaware of the diagnosis, and less than half are treated, and only about 20% have their blood pressure optimally controlled (Hundemer, 2025). In 2024, 1.4billion adults were hypertensive, of which only one in every five individuals (approximately 23%) had their blood pressure under control (WHO, 2025a). Adherence to antihypertensive drugs drops gradually after initiating the pharmacological treatment, about 10% miss their dose once in a while, and almost half of the patients discontinue the medication within a year (Conn, 2015). Bhutan, as a developing country, has many of its population suffering from various kinds of non-communicable diseases such as CVD, hypertension, diabetes mellitus, chronic kidney disease, etc., affecting their daily lives. In 2016, as per the WHO report, 69% of deaths in Bhutan were due to NCDs, CVD, with the highest (Karma Tenzin, 2022). As per a cross-sectional study conducted based on the National Health Survey 2013, reported in Bhutan, of 30,889 participants, 5216 (17%) were prevalent to hypertension (Tashi Dendup, 2020). Most people with hypertension are commonly associated with other chronic comorbidities, such as DM (Diabetes Mellitus), CVD (cardiovascular diseases), CKD (chronic kidney disease), and dyslipidemia. |
| Objectives | The objectives of this pre-post intervention is to assess the impact of pharmacist-led interventions in clinical outcomes (BP), medication adherence (ARMs), and Humanistic Outcomes (EQ-5D-5L) among hypertensive patients with co-morbidities. Poor medication adherence in hypertensive patients, especially those associated with various comorbidities, can lead to health complications. Pharmacist-led intervention can help in improving adherence and related clinical and humanistic outcomes and prevent future complications. Most patients in the age group above 45 in oral anti-hypertensive therapy are also suffering from other chronic diseases, leading to polypharmacy, which is likely to cause poor medication adherence. Pharmacists have direct contact with all these patients and can make noticeable improvements in the patients' health through interventions such as counseling and guided follow-ups. The outcome of every visit is compared with the outcome of the final visit to assess the impact of the intervention. |
| Study Methods | Research Approach The study follows Pre-post Intervention. Assessment is done on their visit with the structured questionnaires for medication adherence, clinical outcome, and Humanistic outcome.Pre-intervention is carried out on the first visit, and the follow-up is planned for every two months.Post-intervention assessment will be conducted every two months for two episodes.The differences in outcomes will be compared to evaluate the effectiveness of intervention. Study Settings The data for the study will be collected from Phuentsholing General Hospital (Bhutan). PGH is one of the general referral hospitals located in the southern region of the country. The hospital is situated in the commercial hub and on the India-Bhutan border, making it a crucial healthcare center for the district and its surrounding areas. The hospital provides all the primary and secondary healthcare services to the local population, visitors from within and outside the country. The hospital is selected based on its best suitability for conducting the study, since the number of OPD patients visiting per day is relatively high compared to other district hospitals. Also, there are many patients on oral antihypertensive agents, thus providing an adequate sample size for the study. PGH also serves as the referral point for the nearby hospitals. The study setting was chosen because the hospital has a well-equipped pharmacy and the clinical staff are cooperative and patient-friendly, making data collection convenient. Sampling Technique Random sampling technique is used for sampling purpose. The participants are selected based on inclusive and exclusive criteria in order to avoid sampling bias. |
| Expected outcomes and use of results | Expected outcomes: The expected outcomes by the end of the given period are to improve the patients’ medication adherence and clinical outcomes (BP). Secondary outcome of the study is humanistic improvement by the the intervention carried out. Expected Output: Publication of data showing the medication adherence before and after interventions. Publication of pharmacist intervention report. |
| Keywords | Pharmacist-led intervention, Hypertension, Comorbidities, Medication Adherence, Bhutan. |
Research Details
| Student research | Yes |
| Institution: Naresuan University, Thailand. | |
| Academic degree: Master | |
| Supervisor of the student(s) | |
| Full Name and title: Dr.Athagran Nakham | |
| Email: athagrann@nu.ac.th | |
| Start Date | 01-Jul-2025 |
| End Date | 30-Apr-2027 |
| Key Implementing Institution | no funding |
| Multi-country research | No |
| Nationwide research | No |
| Bhutan | |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Other (Assessment of medication adherence among NCD patients) |
| Involves human subjects | Yes |
| Intervention Evaluation Research | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Under Review |