Role of Pharmacist in Addressing the Adverse Drug Reactions and Improving the Knowledge of Patients Regarding Their Drug Therapy at Government Civil Hospital Khairpur, Sindh, Pakistan

Adverse Drug Reactions are among the major problems that cause mortality and morbidity in patients worldwide. In this study, Adverse Drug Reactions with common medicines were addressed, and the knowledge of pharmacist for prescribed medicine was also evaluated before and after educating the patients by pharmacist. The duration of this study was one year from Original Research Article Ahmed et al.; JPRI, 33(6): 104-110, 2021; Article no.JPRI.65775 105 October 2016 to October 2017. A descriptive cross-sectional study was designed and completed on 150 patients admitted to the hospital's medical ward. Patients whose ages were between 18-60 years, either male or female, who reported chronic diseases and took medication for a long time were selected for the study. Children or patients having < 18 years and taking medicine for a short period were excluded from this study. Selected patients were evaluated, and results were collected. Finally, the collected data was analysed with the 21 st version of IBM’s Statistical Package for Service Solutions (SPSS v23). Of 150 selected patients, 61% were male, and 39% were female. Most patients were from the 18-30 age group, i.e., 28%. 60% of the patients hail from rural areas, and 40% from an urban areas. Of the 150 patient studied, 36.7% were illiterate, and only 4.7% of patients were above intermediate. Most of the patients were working in different government and private sectors. 8% of those taking the combination of Amoxicillin+Omeprazole+Salbutamol reported side-effects, whereas minimum side effects (2.0%) with Cholorothiazide+Atenolol+ Paracetamol. Reported adverse drug reactions (ADRs) in patients were Headache (14.9%), nausea (13.8%), vomiting (10.3%), abdominal pain (12.6%), constipation (8.0%), diarrhea (10.3%), skin rashes (5.7%), loss of appetite (4.6%), dizziness (6.9%), tiredness (6.9%) and confusion (5.7%). The knowledge of patients regarding therapy was compared before and after counseling that shows increased awareness in patients after counseling the patients. Before counseling average knowledge of patients was 27.5% that increased to 50.3% after counseling. After analyzing the results, it is concluded that pharmacist counseling and providing education to patients can significantly decrease the ADRs and increase the compliance of drugs that will ultimately enhance patients' quality of life. It was recommended that the hospital should appoint the pharmacist, especially a clinical pharmacist, and Hospital administration should arrange the programs for the awareness of patients on appropriate uses of drugs and their side effects.

October 2016 to October 2017. A descriptive cross-sectional study was designed and completed on 150 patients admitted to the hospital's medical ward. Patients whose ages were between 18-60 years, either male or female, who reported chronic diseases and took medication for a long time were selected for the study. Children or patients having < 18 years and taking medicine for a short period were excluded from this study. Selected patients were evaluated, and results were collected. Finally, the collected data was analysed with the 21

INTRODUCTION
Adverse Drug Reactions are among the major problems that cause mortality and morbidity in patients worldwide [1]. One of the essential healthcare process issues is identifying, preventing, and resolving Drug Related Problems (DRPs). A drug-related issue (DRPs) is characterized as 'an occasion or condition, including drug treatment that really or possibly interferes with wanted outcomes [2]. Drug-related problems are categorized into three groups Patient-related potential Drug-related problems: e.g., Non-compliance. Prescriber -related potential Drug-related problems: e.g., No existing indications, same therapeutic effects, improper dosage (Over and under dosage), and improper use.
Drug-related potential Drug-related problems: e.g., Contraindication, Drug-drug interaction, adverse drug reactions treatment [3]. Factors involved in Adverse Drug Reactions are the pressure of patients on the prescriber. Health care system. Marketing tacts. Administration error interaction between two drugs, interaction of disease with drug and Drug-food interactions [4], is essential for pharmacists to provide medication information to the patients. That information can either be related to the patient, as an essential part of pharmaceutical care, or related to the group of patients [5]. Education provided to the patient through counseling has critical importance. By giving education to the patent, the physician may be satisfied that his patient is well educated and will positively inpact patient therapy. Pharmacist take advantage of an increased relationship with his educated patients [6]. Patient education program helps the patient to better cop up with the chronic disease [7]. It has been seen that for some ailment, patients are re-admitted to the medical hospitals. The improved patient education process is an essential way for medical hospitals to lessen readmission rates [8].

METHODOLOGY
A descriptive cross-sectional study was conducted at a government civil hospital, Khairpur; 150 patients were enrolled via nonprobability purposive sampling method from medical wards. The research duration was 12 months, from 20-10-2016 to 20-10-2017. Data was collected by administering a well structured questionnaire. For assessment of ADRs, only those ADRs which were reported by the patients were considered. For patient education assessment, a list of 10 questions was prepared.
Patients were asked the same questions pre and post counseling to assess patients' level of knowledge related to their drug therapy. Data was analysed using IBM's Statistical Package for Service Solutions (SPSS v23).

Inclusive Criteria
All the patients admitted to the medical ward for at least three days were included in the study. All those patients who had complete medical records were included. All Patients between the age of 18-65 years were included. Both males and females were included in the study.

Exclusive Criteria
Patients whose age was less than 18 years, and more than 65 years were excluded. Patients with incomplete medical records were omitted

RESULTS
In this study, 150 patients were selected and evaluated through the non-probability purposive method. Demographic parameters of the study are discussed in Table 1.
The patients were suffering from different chronic diseases. These diseases include; Heart disease in 19 patients (12.7%), Respiratory illness in 34 patients (22.7%), Diabetes mellitus in 31 patients (20.7%), Hepatitis in 17 patients (11.3%), Rheumatoid arthritis in 11 patients (7.3%), Ulcer in 16 patients (10.7%), Urinary tract infection in 13 patients (8.7%) and Epilepsy in 9 patients (6.0%) as shown in Table 2. Table 3 shows side effects reported by the patients, 87 patients out of 150 (58.0%) reported the side effects of drugs. These patients were using different drugs in a different combination, responsible for side effects in patients. The pharmacist asks various patients' questions to check their knowledge regarding their prescribed medicine before and after counseling. Before counseling, the average knowledge of patients was 27.5% that increased up to 50.13% after counseling, as shown in Table 4.

DISCUSSION
A clinical Pharmacist is a person who is responsible for providing drug-related information to the patient in each hospital. His role starts from the admission of the patient till his discharge. The pharmacist will take the complete medical and drug history of patients. Vinks TH. et al. [11] research also focus the elder group of patients, age-associated DRPs, and active role of community pharmacist by providing education. In this study, 27% of selected patients were male, and 73% were female, whereas, in this study, both male and female were in equal ratio, 50% were male, and 50% were female. In this study, 763 different types of DRPs were reported by patients, whereas in this study, patients were not aware of DRPs, ADRs of drugs, and how to report them, so only 79 different types of DRPs were reported by patients. Mostly, patients from rural areas didn't report any physicians' problems; these problems were identified when the pharmacist counseled them and asked them about any unusual drug response. In this study, drug-drug interaction was observed in 17.8% of patients. In contrast, in this study, patients' same unawareness was observed, and only 5.3% of patients were aware of drugdrug interaction. They tell the pharmacist during counseling [11].
Lindenmeyer, A. et al. [12] research the pharmacist role in providing knowledge and guidance to DM-II patients. Results show a clear improvement in the management of DM after counseling the patients [12] similarly; in this study, results clearly show the increase in knowledge of patients after proper counseling of patients such as patients knowledge about drug-specific use before counseling was 73% in patients, whereas after counseling it increases up to 92%. It shows the significance of patients' proper counseling and education in managing diseases during treatment in hospital and after discharge in homes.

CONCLUSION
It is concluded that pharmacist counseling and providing education to patients can significantly decrease the ADRs and increase the compliance of drugs that will ultimately enhance patients' quality of life. It was recommended that the hospital should appoint the pharmacist, especially a clinical pharmacist, and Hospital administration should arrange the programs for the awareness of patients on appropriate uses of drugs and their side effects.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s). Consent was taken from the hospital administration and patients.