Impact of Clinical Pharmacist Interventionson Medication Adherence, LifestyleModification, and CardiometabolicOutcomes in Non-alcoholicFatty Liver Disease
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Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is closely associated with cardiometabolic disorders and is
frequently complicated by suboptimal medication adherence, drug-related problems (DRPs), and inadequate lifestyle
modification. Evidence describing the clinical impact of pharmacist-led interventions in NAFLD management
remains limited. Objectives: The objective of the study was to evaluate the effect of structured clinical pharmacist
interventions on medication adherence, lifestyle behaviors, DRPs, and cardiometabolic outcomes in adults with
NAFLD. Methods: A prospective observational interventional study was conducted over a 12-month follow-up period
at a government general hospital, Anantapur. Adult patients with NAFLD (n = 379) received clinical pharmacist-
led interventions, including medication reconciliation using the best possible medication history approach, DRP
identification based on the Pharmaceutical Care Network Europe classification, physician-directed recommendations,
and individualized counseling on medication use and lifestyle modification. Clinical, biochemical, and patient-reported
outcomes were evaluated at baseline and follow-up visits. Results: Pharmacist-led interventions were associated with
significant improvements in adherence, knowledge, and lifestyle behaviors. A total of 48 clinically relevant DRPs were
identified, with most pharmacist recommendations accepted by physicians. Significant improvements were observed in
cardiometabolic parameters, including hemoglobin A1C (6.82 ± 1.12 vs. 6.34 ± 0.96, P < 0.001), low-density lipoprotein-
cholesterol (P < 0.001), body mass index (P < 0.001), blood pressure, and Fatty Liver Index scores. Correlation analyses
demonstrated significant associations between adherence, satisfaction, and clinical outcomes. Conclusion: Structured
clinical pharmacist interventions improve medication safety, adherence, behavioral outcomes, and cardiometabolic risk
indicators in NAFLD patients, supporting their integration into multidisciplinary care models
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