"ASSESSMENT OF HRQoL IN HEPATIC IMPAIRED PATIENTS: A QUESTIONNAIRE BASED STUDY"

The term health-related quality of life (HRQoL) reflects the impact of the disease upon a person's quality of life. ³ Chronic liver disease patients experience symptoms of fatigue, anxiety, depression, loss of self-esteem, etc. as a result of disease progression including side-effects of treatment specific therapy, which have a huge impact on their HRQoL. Moreover rising medical costs and declining socio-economic conditions further contribute to the deterioration of the patient’s mental health and subsequently, HRQoL. ^[2] CLDQ gave a better understanding of HRQoL in patients with different forms of chronic liver disease and also disease progression. Age and sex did not affect CLDQ scores. Medication nonadherance is a highly prevalent obstacle to achieve and maintain wellness in liver diseased patients.The objective of this study is to to assess the impact of chronic liver disease on quality of life and to determine whether non adherence is a factor for impaired QoL in patients with liver disease. A prospective observational questionnaire based study was conducted in hepatic impaired patients on drug dosing for a period of 6 months in a tertiary care teaching hospital. The degree of hepatic impairment was calculated using Child-Pugh classification .Self-reported medication adherence was examined using the 8-Question Morisky Medication Adherence Scale (MMAS-8).From the 52 CLDQ responses obtained, higher mean scores were found for emotional function [37.01(7.19)] while lower mean scores for activity [11.21(3.72] and abdominal [11.40(3.56)]. The overall CLDQ scores for patients belonging to  Child C [4.82(0.73)] and Child B [4.15(0.80)] were  higher compared to patients belonging to Child A [3.61(0.80)]. Out of  52 patients,  43 (83%) were observed with an overall CLDQ scores less than five  and 9 (17%) patients with an overall CLDQ scores more than or equal to five. Out of 52 patients, 33 had a score less than two and 19 patients with score between 1 or 2 for MMAS-8. Of the 43 patients with an overall CLDQ scores less than five, 27 of them had an MMAS-8 score more than 2 and  16 of them had an MMAS-8 score of 1 or 2. Among the 9 patients with an overall CLDQ score greater than five , 6 patients scored more than 2 and 3 patients scored  1 or 2.  The most affected domains were activity and abdominal symptoms whilst the least affected was Emotional function. In conclusion to our study,  the domains like Activity, Abdominal and Fatigue were equally affected in Child A, Child B and Child C categories. These findings had statistical significance with  P-value <0.05.Our objective on determining the impact of adherence on QoL was successful in highlighting a positive correlation between low medication adherence and poor QoL. This finding was statistically significant with P-value of 0.048. Our conclusion from the  CLDQ responses collected is that a major population had poor HRQoL.