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Table of Contents
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 61-65

The Impact of Counseling in Patients with Chronic Obstructive Pulmonary Disease: Knowledge, Attitude, and Practice Outcome

Department of Pharmacology, Uka Tarsadia University, Bardoli, Gujarat, India

Date of Submission26-Jun-2020
Date of Decision01-Sep-2020
Date of Acceptance16-Sep-2020
Date of Web Publication12-Jan-2021

Correspondence Address:
Mr. Dhaval B Joshi
Department of Pharmacology, Uka Tarsadia University, Bardoli - 394 350, Gujarat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JIHS.JIHS_23_20

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Background: The pharmacists can contribute to positive therapeutic outcomes by educating patients for rational use of medications. A chronic obstructive pulmonary disease (COPD) is one the most prevalent chronic respiratory diseases which requires continuous medication therapy. The clinical pharmacist can play an effective role through providing patient counselling to improve medication adherence and therapeutic outcomes. Aims and Objectives: The present study aims to assess the baseline levels of knowledge, attitude and practice of COPD patients and to study the impact of patient counselling on level of knowledge, attitude and practice with COPD patients. Materials and Methods: A total 90 patients (45 in the test group and 45 in control group) were enrolled in the study. A validated Knowledge, Attitude and Practice (KAP) Questionnaire was administered to both test and control group of patients at base line and at follow up (after 15 days) to assess the awareness regarding disease management. Patients in test group received counselling at visit and information leaflets were given. The control group of patients did not receive such counselling and information leaflets. Results: At the end of study the KAP scores of test group patients improved significantly (P<0.05), whereas no significant changes were observed in control group patients. We did not observed significant improvement in practice outcomes. However, patients counselling by a pharmacist improved overall KAP score. Conclusion: We conclude that pharmacist counselling may have an impact in improving the perception about disease and lifestyle change and thereby improving the Quality of life (QOL) of COPD patients.

Keywords: Chronic obstructive pulmonary disease, clinical pharmacist, knowledge, attitude and practice score, patient counselling, therapeutic outcome

How to cite this article:
Khadela A, Joshi DB, Vyas B, Patel E. The Impact of Counseling in Patients with Chronic Obstructive Pulmonary Disease: Knowledge, Attitude, and Practice Outcome. J Integr Health Sci 2020;8:61-5

How to cite this URL:
Khadela A, Joshi DB, Vyas B, Patel E. The Impact of Counseling in Patients with Chronic Obstructive Pulmonary Disease: Knowledge, Attitude, and Practice Outcome. J Integr Health Sci [serial online] 2020 [cited 2023 Mar 28];8:61-5. Available from: https://www.jihs.in/text.asp?2020/8/2/61/306716

  Introduction Top

A patient counseling is both an art and science. It is a science because of its underlying principles and art because of the blend of the counselor's personality, technique, and skill. It is about educating patients regarding the disease, medications, and lifestyle changes required to obtain optimum therapeutic outcomes.[1] As for each patient, the provided treatment is different, there cannot be any universal or predetermined methods for counseling.

The objective of the patient counseling is to provide directions, instructions, advice about the drugs which are prescribed and also to imply a positive behavior which motivates the patient for following proper drug adherence.[2] The pharmacists can contribute to positive therapeutic outcomes by educating and counseling patients for preparing and motivating them for rational use of medications.[3] This helps to achieve adequate medication adherence, prolonging life, and improving the patients' health-related quality of life (QOL). In chronic illness, due to complexity and longer duration of treatment, clinical pharmacists can provide effective patient counseling to improve medication adherence and treatment efficiency.[4]

Chronic obstructive pulmonary disease (COPD) is a chronic lung condition which predominantly develops from long-term exposure to cigarette smoking, resulting in irreversible dilation and destruction of lung parenchyma. It is the second-most common noninfectious disease in the world, causing approximately 2.7 million deaths annually, and global mortality is predicted to be more than double by 2030.[5] In India, it is accounted for 2.8% of total deaths in 1990, and it is expected to rise to 6.5% deaths by 2020.[6] Discontinuation of smoking is one of the single most important interventions known to be effective in modifying the disease. Patient education is an important aspect of management programs for patients with COPD.[7] It is recommended to provide education at the time of diagnosis and to continue through end-of-life care. Its goal is to increase medication adherence as well to improve clinical outcomes.[8],[9],[10] In chronic disease like COPD, the patients need to take medications throughout the life. In the Indian rural setup, majority of the patients are illiterate and have poor health literacy, which may lead to misuse of drugs, improper usage, drug-induced disorder or failure of ongoing treatment.[11] In order to overcome this problem, rational use of the medication process has to be adopted by introducing “Patient counseling” and conducting frequent interaction sessions with patients in a view to optimize medication adherence and therapeutic outcomes.

Understanding the level of knowledge, attitude, and practice (KAP) will allow for a more efficient process of awareness creation among the people.[12],[13] There are numerous studies with emphasizing mainly on the epidemiology of COPD from South India.[6] However, despite our extensive literature search, we could not find any KAP based study of COPD patients, especially from the south Gujarat region. Therefore, we planned a study to assess the demographic details of COPD patients along with analysis of their KAP outcomes in a view to understand the impact of through patient counseling for COPD patients.

  Methods Top

This was an observational study conducted in a tertiary care hospital for 6 months. A total of 90 patients fulfilling the study criteria have been enrolled in the study. Among these 90 patients, 45 were in the control group (CG) and 45 were in the test group (TG). All the patients who were diagnosed with COPD were enrolled in the study after receiving prior consent. The pregnant women, mentally ill patients, and patients having comorbidities along with COPD were excluded.

Patient data collection

The patient data collection form was prepared for systematic collection of all clinical details of the patients. Patient data collection form included details such as patient demographic data, clinical features, chief complaints, physical examination, history (Medical and Medication History), laboratory Investigations, diagnosis, drug treatment. The patient counseling regarding the disease, medications, and lifestyle modifications has been provided to the study participants in TG and recorded in patient counseling documentation form.

Enrolment of patients

Patients greater than the age of 18 who were suffering from COPD were enrolled. They were randomly assigned to Group-A (Control) Or Group-B (test). The method of randomization applied was simple randomization. The patients who enrolled in Group-A (control) were not received detailed counseling from the clinical pharmacist. The patients who enrolled in Group-B (test) were provided were received a specific counseling and education regarding the fundamental knowledge of COPD and its management.

Evaluation of knowledge, attitude, and practice

The KAP questionnaire was prepared in two languages: Gujarati and English. The KAP questionnaire was validated by performing the pilot study consisting of 25 study participants. Among the 25 study participants, 5 subjects were from a medical background. It consisted of total of 18 questions: 10 knowledge-related, 5 attitude-based, and 3 practice-based questions. The patients were interviewed about their KAP regarding COPD and the baseline score was obtained and evaluated by clinical pharmacist for both the groups. After providing counseling to the TG the new KAP score was obtained and evaluated.

Ethical approval

The study protocol was approved by the human research ethics committee of Maliba Pharmacy College (Reference no. MPC/HREC/04/2013-14; dated: 10/07/2014).

  Results Top

A total of 90 patients fulfilling the inclusion and exclusion criteria were enrolled in the study and were randomized into “test” and “control” groups. The distribution of COPD patients, according to the sociodemographic characteristics, is shown in [Table 1].
Table 1: The sociodemographic characteristics of patients

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Total medications/drugs per prescription

Average number of drugs per prescription was found to be 5.033. Minimum number of drugs per prescription was found to be 2 and maximum number of drugs per prescription was found to be ≥ 6.

Chronic obstructive pulmonary disease medications/drugs per prescription

Average number of drugs per prescription was found to be 3.3. Minimum number of drugs per prescription was found to be 2 and maximum number of drugs per prescription was found to be 7.


Effect of pharmacist counseling was studied using a KAP questionnaire. On analyzing the responses, the percentage of patients who answered correctly were more at the final follow-up compared to the baseline in the TG. Even though the overall KAP scores of the TG were significantly (P < 0.05) higher at the end of the study [Figure 1],[Figure 2],[Figure 3].
Figure 1: Score obtained for knowledge domain in control and test groups before and after follow-up

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Figure 2: Score obtained for attitude domain in control and test groups before and after follow-up

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Figure 3: Score obtained for practice domain in control and test groups before and after follow-up

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The individual and total KAP scores of each group (control and test) were analyzed. The KAP score of TG patients improved significantly after counseling as compared to CG.

The follow-up scores for knowledge (5.133 ± 2.133) and attitude (4.866 ± 1.302) domains obtained for CG were almost near to baseline scores of knowledge (4.6 ± 2.063) and attitude (4.66 ± 1.345). However, the follow-up score for knowledge (8.133 ± 1.060) and attitude (8.066 ± 1.099) domains obtained for TG were significantly improved as compared to the baseline scores of knowledge (4.066 ± 1.791) and attitude (5.133 ± 1.767). The practice domain the baseline score was 1.6 ± 0.910 and 1.933 ± 0.961 in control and test group respectively, and the slight nonsignificant change was recorded in follow-up score of TG (2.133 ± 1.060) after providing patient counseling whereas in the CG it got declined (1.466 ± 0.743) [Table 2].
Table 2: Knowledge, attitude, and practice score of control and test group

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  Discussion Top

For the patients suffering from chronic diseases, it is foremost important to understand an etiology, symptoms, and complications along with the appropriate use of medications and possible adverse effects in a view to achieve an optimum therapeutic outcomes. COPD is one of the common chronic respiratory diseases, which very frequently affects mainly chronic smokers and even other people who are at risk. There have been many studies conducted to understand epidemiology and a clinical pattern of COPD along with medication-related problems. The results of some selected studies have been compared with our findings to get an idea of how impactful the patient counseling is on such patients.

Lundbäck et al. have found that almost 50% of smokers may develop COPD, which indicates that smoking is one of the major risk factors for the development of COPD.[14] Therefore, there is a definite need to aware of the patients regarding the harmful effects of tobacco substances. In our study, the majority of the patients (93.3%) were past smokers (smokers before diagnosed with COPD), and therefore, it is very essential to impart counseling regarding the smoking cessation or avoidance of any kind of tobacco abuse.

Stoilkova et al. carried out a systematic review on Educational Programmes in COPD management interventions, which have shown that disease and management related counseling plays pivotal role in achieving optimum therapeutic outcomes.[15] Gupta et al. suggested that better patient education is necessary to improve the management of COPD.[16] As in our study, most of the patients (86.6% and 66.6% in test and CG respectively) were found to be below the metric level, and it is inevitable for them to educate about the basics of disease and its management to control the disease progression.

The practice guidelines of the global strategy for chronic obstructive lung disease and the American thoracic society/European respiratory Society have shown the important role of educational components in COPD management interventions.[9],[17] Upadhyay et al. and Saadia et al. have reported in their studies that patient education plays a pivotal role in the improvement of KAP score.[18],[19] The KAP questionnaire used in this study was developed to assess the perception of the patients about their disease and to assess the change in the perception after the counselling.

The KAP score of TG patients improved significantly (P < 0.05) after counseling as compared to the CG. In our study, initially, the patients' KAP score was not satisfactory in both control (10.86 ± 0.86) and test (11.13 ± 0.79) group before providing patient counseling. In the CG, the KAP score (11.46 ± 0.80) was not improved after 15 days of follow-up even though the patients were on medications as they might not have been provided with disease and medication-related counseling. However, in the TG the KAP score (18.4 ± 0.65) was significantly improved after providing patient counseling regarding disease and its management. Clinical pharmacist involvement in disease management has a positive impact on creating awareness about the disease and its usage and in improving the QOL.

  Conclusion Top

COPD patients were counseled thoroughly regarding COPD and the medications used in it. The role of the pharmacist has been limited from filling the prescriptions to dispensing of medication to patients in majority of developing nations. However, the study result proposes that a counseling conducted by pharmacist may have an impact on improving understanding of disease condition and correct administration and handling of medications, which directly improves patient mediation adherence and therapeutic outcomes. In this context, this study proves a significant role of clinical pharmacists in obtaining the optimum therapeutic outcomes by providing effective patient counseling.


The prior knowledge of disease may affect the perception of the study participants and can mislead the actual KAP score.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Hassan WE. Pharmacy communication. In: Hospital Pharmacy. 5th ed.. Philadelphia: Lea & Febiger; 1986. p. 154-9.  Back to cited text no. 2
Popovich NG. The impact of Counselling in patients with Chronic Obstructive Pulmonary Disease: Knowledge, Attitude and Practice outcome. In: Gennaro AR. editor. 19th ed.. Easton PA: Mack Publishing; 1995. p. 1695-719.  Back to cited text no. 3
Palaian S, Prabhu M, Shankar PR. Patient counseling by pharmacist-a focus on chronic illness. Pak J Pharm Sci 2006;19:65-72.  Back to cited text no. 4
Mathers CD, Boerma T, Ma Fat D. Global and regional causes of death. Br Med Bull 2009;92:7-32.  Back to cited text no. 5
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Global Initiative for chronic Obstructive pulmonary Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease 2019. Available from: https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf.  Back to cited text no. 9
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Sekhar S, Abraham S, Revikumar KG. Emerging trends in practice of patient counselling-Indian scenario. Indian J Pharm Pract 2008;1:6-13.  Back to cited text no. 13
Lundbäck B, Lindberg A, Lindström M, Rönmark E, Jonsson AC, Jönsson E, et al. Not 15 but 50% of smokers develop COPD?--Report from the obstructive lung disease in northern Sweden studies. Respir Med 2003;97:115-22.  Back to cited text no. 14
Stoilkova AN, Daisy JA, Emiel FM. Educational programmes in COPD management intervention: A systemic review. J Respir Med 2013;107:1637-50.  Back to cited text no. 15
Gupta SK, Singh JL, Rathod AM. To study the attitudes, beliefs and perception regarding the use of inhalers among patients of obstructive pulmonary diseases and in the general population in Punjab. J Clin Diagn Res 2011;5:434-9.  Back to cited text no. 16
Eisner MD, Anthonisen N, Coultas D, Kuenzli N, Perez-Padilla R, Postma D, et al. An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010;182:693-718.  Back to cited text no. 17
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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2]


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