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Ahmed A, Saqlain M, Tanveer M, Blebil AQ, Dujaili JA, Hasan SS. The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review. BMC Health Serv Res 2021; 21:859. [PMID: 34425816 PMCID: PMC8381566 DOI: 10.1186/s12913-021-06897-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The pharmacist's role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists' clinical roles in improving Pakistani patients' therapeutic, safety, humanistic, and economic outcomes. METHODS We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed. RESULTS The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions. CONCLUSIONS The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients' health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Maria Tanveer
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Ali Qais Blebil
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
| | - Syed Shahzad Hasan
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Huddersfield, UK
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Ahmed A, Abdulelah Dujaili J, Rehman IU, Lay Hong AC, Hashmi FK, Awaisu A, Chaiyakunapruk N. Effect of pharmacist care on clinical outcomes among people living with HIV/AIDS: A systematic review and meta-analysis. Res Social Adm Pharm 2021; 18:2962-2980. [PMID: 34353754 DOI: 10.1016/j.sapharm.2021.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pharmacists play a significant role in the multidisciplinary care of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). However, there is less evidence to clarify the impact of pharmacist as an individual team member on HIV care. OBJECTIVE This study aims to determine the effects of pharmacist intervention on improving adherence to antiretroviral therapy (ART), viral load (VL) suppression, and change in CD4-T lymphocytes in PLWHA. METHODS We identified relevant records from six databases (Pubmed, EMBASE, ProQuest, Scopus, Cochrane, and EBSCOhost) from inception till June 2020. We included studies that evaluated the impact of pharmacist care activities on clinical outcomes in PLWHA. A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and mean difference (MD) for continuous data] with 95% confidence intervals (CIs). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence. The review protocol was published on PROSPERO (CRD42020167994). RESULTS Twenty-five studies involving 3206 PLWHA in which pharmacist-provided intervention either in the form of education with or without pharmaceutical-care either alone or as an interdisciplinary team member were included. Eight studies were randomized controlled trials (RCTs), while 17 studies were non-RCTs. Pooled-analyses showed a significant impact of pharmacist care compared to usual care group on adherence outcome (OR: 2.70 [95%, CI 1.80, 4.05]), VL suppression (OR: 4.13 [95% CI 2.27, 7.50]), and rise of CD4-T lymphocytes count (MD: 66.83 cells/mm3 [95% CI 44.08, 89.57]). The strength of evidence ranged from moderate, low to very low. CONCLUSION The findings suggest that pharmacist care improves adherence, VL suppression, and CD4-T lymphocyte improvement in PLWHA; however, it should be noted that the majority of the studies have a high risk of bias. More research with more rigorous designs is required to reaffirm the impact of pharmacist interventions on clinical and economic outcomes in PLWHA.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Pakistan.
| | - Alice Chuah Lay Hong
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia.
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, 54000, Lahore, Pakistan.
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia; College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Imeri H, Toth J, Arnold A, Barnard M. Use of the transtheoretical model in medication adherence: A systematic review. Res Social Adm Pharm 2021; 18:2778-2785. [PMID: 34275751 DOI: 10.1016/j.sapharm.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medication nonadherence is an important public health issue that has individual and system-level implications. Nonadherence can lead to negative health outcomes and illness, which in turn produce increased healthcare costs for both the individual and system. The transtheoretical model of change (TTM) can be a useful basis for interventions, as it can identify patients' current stages of change and guide them from nonadherence to adherence. OBJECTIVE The objective of this systematic review was to determine the utilization of the TTM to predict or improve medication adherence in patients with chronic conditions. METHODS A systematic review of current literature was conducted to obtain an overview of the use of TTM-informed interventions for medication adherence in chronic conditions. PubMed, Embase, PsycInfo and CINAHL databases were searched in July 2020. The methodological quality of the studies was evaluated using the Downs and Black checklist. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for data extraction, analysis, and reporting. RESULTS Ten studies were included in the final data synthesis of this review. Eight of the reviewed studies supported the utility of TTM to predict or improve medication adherence in patients with chronic conditions, while two studies did not find any significant improvement in medication adherence after using a TTM-based intervention. The Downs and Black checklist revealed the overall methodological quality of the included studies to be fair [mean (SD) = 16.3 (4.5) of a possible maximum score of 28]. CONCLUSION This systematic review provides an overview of the utility of TTM in predicting and improving medication adherence in patients with chronic conditions. Although TTM-based interventions in patients with low or moderate medication adherence were effective, there were few studies identified, suggesting the need for further research.
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Affiliation(s)
- Hyllore Imeri
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA.
| | - Jennifer Toth
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA.
| | - Austin Arnold
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA.
| | - Marie Barnard
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA.
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Presley B, Groot W, Widjanarko D, Pavlova M. Preferences for pharmacist services to enhance medication management among people with diabetes in Indonesia: A discrete choice experiment. PATIENT EDUCATION AND COUNSELING 2021; 104:1745-1755. [PMID: 33358372 DOI: 10.1016/j.pec.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To elicit patients' preferences for pharmacist services that can enhance medication management among people with diabetes in Indonesia. METHODS A discrete choice experiment (DCE) among 833 respondents with diabetes in 57 community health centers (CHCs) and three hospitals in Surabaya, Indonesia. Consultation was the baseline service. Four attributes of consultation and two attributes of additional services were used in the DCE profiles based on literature and expert opinion. The DCE choice sets generated were partially balanced and partially without overlap. Random effect logistic regression was used in the analysis. RESULTS Respondents preferred a shorter duration of consultation and flexible access to the pharmacist offering the consultation. A private consultation room and lower copayment (fee) for services were also preferred. Respondents with experience in getting medication information from pharmacists, preferred to make an appointment for the consultation. Total monthly income and experience with pharmacist services influenced preferences for copayments. CONCLUSION Differences in patients' preferences identified in the study provide information on pharmacist services that meet patients' expectations and contribute to improve medication management among people with diabetes. PRACTICE IMPLICATION This study provides insight into evaluating and designing pharmacist services in accordance with the preferences of people with diabetes in Indonesia.
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Affiliation(s)
- Bobby Presley
- Department of Health Services Research (HSR), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands; Department of Clinical and Community Pharmacy, Center for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, 60293, Surabaya, East Java, Indonesia.
| | - Wim Groot
- Department of Health Services Research (HSR), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Doddy Widjanarko
- Dr. Mohammad Soewandhie Public Hospital, Tambak Rejo 45-47, 60142, Surabaya, East Java, Indonesia.; Faculty of Medicine, Hang Tuah University, Gadung No. 1, Jagir, 60111, Surabaya, East Java, Indonesia
| | - Milena Pavlova
- Department of Health Services Research (HSR), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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He Q, Silverman CL, Park C, Tiu GF, Ng BP. Prescription drug coverage satisfaction, cost-reducing behavior, and medication nonadherence among Medicare beneficiaries with type 2 diabetes. J Manag Care Spec Pharm 2021; 27:696-705. [PMID: 34057396 PMCID: PMC10391046 DOI: 10.18553/jmcp.2021.27.6.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Medication nonadherence in individuals with type 2 diabetes can lead to poor glycemic control, resulting in increased risk for diabetes-related complications. OBJECTIVE: To examine associations between factors (ie, drug coverage satisfaction and cost-reducing behavior) and medication nonadherence among Medicare beneficiaries with type 2 diabetes. METHODS: We analyzed the 2016 Medicare Current Beneficiary Survey Public Use File for beneficiaries aged 65 years and older with reported type 2 diabetes (n=1,430; weighted n=5,846,943). Medicare beneficiaries were considered to have medication nonadherence if they reported skipping doses or taking smaller doses than prescribed. A survey-weighted logistic model, adjusted for sociodemographics and comorbidities, was conducted to examine associations of drug coverage satisfaction and cost-reducing behavior with medication nonadherence. RESULTS: Among Medicare beneficiaries aged 65 years and older with type 2 diabetes, 10.3% reported medication nonadherence. In the adjusted analysis, the risk for medication nonadherence was higher among those who were dissatisfied with the amount paid for medications (OR = 2.43; P = 0.002) compared with those who were satisfied, and those who spent less on basic needs to save for medications were more likely to report medication nonadherence (OR = 2.23; P = 0.011) than those who did not. CONCLUSIONS: Our findings suggest that medication nonadherence among Medicare beneficiaries with type 2 diabetes is associated with dissatisfaction with the amount paid for medications and cost-reducing behavior. Interventions that lower medication costs for Medicare beneficiaries may help to improve medication adherence among this at-risk population. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to disclose.
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Affiliation(s)
- Qing He
- Department of Statistics and Data Science, University of Central Florida, Orlando
| | - Ciara L Silverman
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin
| | - Georgianne F Tiu
- Department of Health Management and Policy, University of Kentucky, Lexington
| | - Boon Peng Ng
- College of Nursing and Disability, Aging, and Technology Cluster, University of Central Florida, Orlando
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Okoro RN, Nduaguba SO. Community pharmacists on the frontline in the chronic disease management: The need for primary healthcare policy reforms in low and middle income countries. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 2:100011. [PMID: 35481111 PMCID: PMC9032016 DOI: 10.1016/j.rcsop.2021.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/31/2021] [Accepted: 04/11/2021] [Indexed: 11/02/2022] Open
Abstract
In low- and middle-income countries (LMICs), over 12 million people die yearly from chronic diseases and this number is expected to increase if concerted actions are not taken. The purpose of this paper is to highlight the roles and impact of community pharmacists in chronic disease management support and the need for policymakers in LMICs to reposition community pharmacists appropriately for this extended role. Recent findings have shown that community pharmacists are the most accessible healthcare providers to the members of the community. Published evidence have demonstrated that community pharmacists' interventions in chronic diseases significantly improve economic, clinical, and humanistic outcomes. However, they are not officially recognized as primary healthcare providers in LMICs. Therefore, there is need for policy reforms that will encourage strategic use of the clinical skills of community pharmacists as part of the primary healthcare team in LMICs.
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Alexandre K, Campbell J, Bugnon M, Henry C, Schaub C, Serex M, Elmers J, Desrichard O, Peytremann-Bridevaux I. Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews. JBI Evid Synth 2021; 19:1003-1118. [PMID: 33741836 DOI: 10.11124/jbies-20-00020] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this review was to identify and describe the factors influencing diabetes self-management in adults by summarizing the available evidence concerning their types, categories, and relative importance. INTRODUCTION A wide range of factors, acting simultaneously, influence diabetes self-management and interfere with its actual application by patients. There is a variety of systematic reviews of these factors; however, a more thorough examination of their influences was lacking. INCLUSION CRITERIA Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included. METHODS We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (eg, facilitator/barrier, strength and direction of association), categories (eg, demographic, social), and frequency of occurrence. RESULTS We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences were psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management. CONCLUSIONS Essential components of interventions to promote effective diabetes self-management should aim to help adults manage the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, as depression is a particular obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, researchers should examine non-modifiable factors - age, sex, or socioeconomic status - in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018084665.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Joan Campbell
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Marie Bugnon
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
| | - Cristina Henry
- Association Vaudoise d'Aide et de Soins À Domicile (AVASAD), Lausanne, Switzerland
| | - Corinne Schaub
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Magali Serex
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Jolanda Elmers
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
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Alfian SD, van Boven JFM, Iskandarsyah A, Abdulah R, Hak E, Denig P. Process Evaluation of Implementing a Pharmacist-Led Intervention to Improve Adherence to Antihypertensive Drugs Among Patients with Type 2 Diabetes in Indonesian Community Health Centers. Front Pharmacol 2021; 12:652018. [PMID: 34025419 PMCID: PMC8131821 DOI: 10.3389/fphar.2021.652018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: A pharmacist-led intervention in Community Health Centers (CHCs) in Indonesia targeted at patients with type 2 diabetes non-adherent to antihypertensive drugs resulted in a significant improvement in adherence to these drugs. The aim of this study was to evaluate the process of implementation this intervention intended to improve adherence to antihypertensive drugs from both the pharmacist and the patient perspective. Methods: Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, we conducted a focus group among pharmacists (N = 5) and a survey among patients with complete follow-up (N = 44) participating in the intervention group. Results: All pharmacists adopted the provided training and found support tools useful. The pharmacists implemented the intervention as intended (adequate intervention fidelity >69%). Factors relevant for implementation included having sufficient time and confidence, home visits for specific patients, multidisciplinary collaboration, and availability of a personal counseling room. To maintain the intervention, the need for practical guidance and support from health care authorities was mentioned. Most patients (96%) were satisfied with the information provided by the pharmacists and they believed the tailored counselling was helpful. Most patients (84%) reported that the duration of counselling was sufficient. The large majority of patients would like to receive the counselling regularly. Conclusion: Positive effects of the pharmacist-led intervention can be explained by adequate levels of reach, adoption and implementation in the participating CHCs. For successful implementation and maintenance in Indonesia or other low-and middle-income countries, sufficient training, resources, multidisciplinary collaboration, guidance and support from health care authorities are expected to be important.
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Affiliation(s)
- Sofa D Alfian
- Unit Pharmaco-Therapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands.,Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.,Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.,Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
| | - Aulia Iskandarsyah
- Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.,Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Eelko Hak
- Unit Pharmaco-Therapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands.,Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.,Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
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Sah SK, R S, Ramesh M, Chand S. Impact of pharmacist care in the management of autoimmune disorders: A systematic review of randomized control trials and non-randomized studies. Res Social Adm Pharm 2021; 17:1532-1545. [PMID: 33423904 DOI: 10.1016/j.sapharm.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/12/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Autoimmune disorders are chronic, self-mediated, misdirected immune responses against their own immune system. It required intensive, complex and costly drug treatment regimen increased the risk of pharmacotherapy error and adversely affects patients. Hence, pharmacist care will have vital roles in autoimmune disorders to achieve health related outcomes. OBJECTIVES This review aimed to gather evidence on the impact of pharmacist care on clinical, humanistic and economic outcomes, adherence to medications, and drug related problems in the management of autoimmune disorders among the usual care group. METHODOLOGY A comprehensive review conducted in compliance with the PRISMA statement and systematic search was performed across five databases included PubMed Central, Web of Sciences, Scopus, Cochrane Library andgoogle scholar from inception until August 2020. This research included full-text articles of randomized and non-randomized studies that evaluated impact of pharmacist care in autoimmune disorders. RESULTS A total of nine studies were included (seven RCTs and two non-RCTs), including 829 patients with autoimmune disorders. A total of four studies (80%) show an enhancement in at least one clinical parameter due to pharmacist care. A substantial improvement in at least one humanistic parameter observed in all five studies (100%). While four out of five studies (80%) clearly displayed a remarkable improvement in medication adherence in the pharmacist care group from baseline to the completion of follow-ups. One study quantified a 99.08% resolution of DRPs in the pharmacist care group. Another study estimated the cost of medical resources uses per patient and found no difference in cost-effectiveness over six months between groups. CONCLUSION This review reinforces the vital contribution of pharmacists to achieve clinical outcomes, humanistic outcomes, adherence to medications and DRPs in the efficient management of autoimmune disorders. However, no notable changes in economic outcomes were observed in this review.
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Affiliation(s)
- Sujit Kumar Sah
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, Karnataka, India.
| | - Subramanian R
- Department of Rheumatology & Immunology, JSS Medical College & Hospital, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, Karnataka, India.
| | - Madhan Ramesh
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, SS Nagar, Mysuru, 570015, Karnataka, India.
| | - Sharad Chand
- Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to Be University), Paneer, Deralakatte, Mangaluru, 575018, Karnataka, India.
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Truong MBT, Ngo E, Ariansen H, Tsuyuki RT, Nordeng H. The effect of a pharmacist consultation on pregnant women's quality of life with a special focus on nausea and vomiting: an intervention study. BMC Pregnancy Childbirth 2020; 20:766. [PMID: 33298010 PMCID: PMC7727235 DOI: 10.1186/s12884-020-03472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Maternal wellbeing and quality of life (QOL) are increasingly being recognized as important for healthy pregnancies. The aim of this study was to investigate the impact of a pharmacist consultation on pregnant women’s QOL focusing on nausea and vomiting in pregnancy (NVP), and patient satisfaction. Methods For this intervention study in 14 community pharmacies, women in early pregnancy were recruited and assigned to a pharmacist consultation (intervention) or standard care (control). The consultation aimed to address each woman’s concerns regarding medications and pregnancy-related ailments. Data were collected through online questionnaires at baseline (Q1) and during the second trimester (Q2). The intervention group completed an additional satisfaction questionnaire after the consultation was completed. The primary outcome was the impact of the intervention on the Quality of Life Scale (QOLS) scores between the first and second trimesters. The impact of the intervention was assessed by linear regression, and secondary analyses were performed to assess effect modification by NVP. Results Of the 340 women enrolled in the study, we analyzed data for 245. Half (170/340) of the original participants were allocated to the intervention group, of whom 131 received the pharmacist consultation. Most women (75%, 78/96) reported that the consultation was useful to a large/very large extent. The consultation had no overall impact on QOLS scores between the first and the second trimesters compared with standard care (adjusted β: 0.7, 95% CI: -2.1, 3.4). The impact of the intervention on QOLS was greater amongst women with moderate/severe NVP (adjusted β: 3.6, 95% CI: -0.6, 7.7) compared to those with no/mild NVP (adjusted β: -1.4, 95% CI: -5.1, 2.2) (interaction term study group*NVP severity, p = 0.048). Conclusions The pregnant women highly appreciated the pharmacist consultation, but the intervention did not affect their QOL scores compared with standard care. Future studies should further explore the effect of a pharmacist consultation specifically for NVP and on other outcomes such as use of health care services and medication use in pregnancy. Trial registration Retrospectively registered in ClinicalTrials.gov (identifier: NCT04182750, registration date: December 2, 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03472-z.
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Affiliation(s)
- Maria Bich-Thuy Truong
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway.
| | - Elin Ngo
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | | | - Ross T Tsuyuki
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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Iqbal A, David Knaggs R, Anderson C, Toh LS. Role of pharmacists in optimising opioid therapy for chronic non-malignant pain; A systematic review. Res Social Adm Pharm 2020; 18:2352-2366. [PMID: 33309322 DOI: 10.1016/j.sapharm.2020.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Opioid optimisation is a global issue in Chronic Non-malignant Pain (CNMP) management. OBJECTIVE This systematic review aims to assess the effectiveness of interventions delivered by pharmacists in outpatient clinical settings, community pharmacies and primary care services in optimising opioid therapy for people with CNMP and to explore stakeholders' opinions about role of pharmacists in optimising opioid therapy. METHODS We conducted searches in PubMed, CINAHL, Psych Info, EMBASE, ISI Web of Science and Conference Proceedings and International Pharmaceutical Abstracts. All studies where pharmacists in outpatient clinical settings, community pharmacies and patient care services helped in optimisation of opioids in the treatment of CNMP as individuals or part of a team were included. Authors followed the 27-item PRISMA guidelines and the review was registered in PROSPERO. All authors were involved in screening and selection of studies and included studies between January 1990-June 2020. Studies not published in English language and participants with cancer pain were excluded. All the included studies were descriptively synthesized. RESULTS Fourteen studies were included in the final data synthesis of this review and the total number of participants in all studies was 1175. Interventions by pharmacists were successful in decreasing opioid dose in 4 studies and improved patient opioid safety in 5 studies. Stakeholders considered that the role of pharmacists in optimisation of opioid therapy for people with CNMP can be promising and should be further developed. CONCLUSION This systematic review gives an overview of pharmacist intervention feasibility, stakeholders' opinions and possible benefits on opioid optimisation in people with CNMP in outpatient clinical settings, community pharmacies and primary care settings. However, further research is warranted, which can guide the development of new policies and guidelines for the utilisation of pharmacists to promote opioid safety in people using prescription opioids for CNMP management.
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Affiliation(s)
- Ayesha Iqbal
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, NG7 2RD, Nottingham, United Kingdom.
| | - Roger David Knaggs
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, NG7 2RD, Nottingham, United Kingdom; Primary Integrated Community Solutions, Unit H4 Ash Tree Court, Nottingham Business Park, Nottingham NG8 6PY, United Kingdom.
| | - Claire Anderson
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, NG7 2RD, Nottingham, United Kingdom.
| | - Li Shean Toh
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, NG7 2RD, Nottingham, United Kingdom.
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62
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Shiyanbola OO, Huang YM. Reducing the rates of diabetes across the United States. J Am Pharm Assoc (2003) 2020. [DOI: 10.1016/j.japh.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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63
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Cornelissen D, de Kunder S, Si L, Reginster JY, Evers S, Boonen A, Hiligsmann M. Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review. Osteoporos Int 2020; 31:1645-1669. [PMID: 32358684 PMCID: PMC7423788 DOI: 10.1007/s00198-020-05378-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/04/2020] [Indexed: 01/25/2023]
Abstract
An earlier systematic review on interventions to improve adherence and persistence was updated. Fifteen studies investigating the effectiveness of patient education, drug regimen, monitoring and supervision, and interdisciplinary collaboration as a single or multi-component intervention were appraised. Multicomponent interventions with active patient involvement were more effective. INTRODUCTION This study was conducted to update a systematic literature review on interventions to improve adherence to anti-osteoporosis medications. METHODS A systematic literature review was carried out in Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov , NHS Centre for Review and Dissemination, CINHAL, and PsycINFO to search for original studies that assessed interventions to improve adherence (comprising initiation, implementation, and discontinuation) and persistence to anti-osteoporosis medications among patients with osteoporosis, published between July 2012 and December 2018. Quality of included studies was assessed. RESULTS Of 585 studies initially identified, 15 studies fulfilled the inclusion criteria of which 12 were randomized controlled trials. Interventions were classified as (1) patient education (n = 9), (2) drug regimen (n = 3), (3) monitoring and supervision (n = 2), and (4) interdisciplinary collaboration (n = 1). In most subtypes of interventions, mixed results on adherence (and persistence) were found. Multicomponent interventions based on patient education and counseling were the most effective interventions when aiming to increase adherence and/or persistence to osteoporosis medications. CONCLUSION This updated review suggests that patient education, monitoring and supervision, change in drug regimen, and interdisciplinary collaboration have mixed results on medication adherence and persistence, with more positive effects for multicomponent interventions with active patient involvement. Compared with the previous review, a shift towards more patient involvement, counseling and shared decision-making, was seen, suggesting that individualized solutions, based on collaboration between the patient and the healthcare provider, are needed to improve adherence and persistence to osteoporosis medications.
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Affiliation(s)
- D Cornelissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands.
| | - S de Kunder
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - L Si
- The George Institute for Global Health, UNSW Sydney, Kensington, Australia
| | - J-Y Reginster
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - S Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands
- Centre for economic evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - A Boonen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands
- Department of Internal Medicine, Rheumatology, Maastricht University Medical Centre and CAPHRI, Maastricht University, Maastricht, Netherlands
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands
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The Consequences of General Medication Beliefs Measured by the Beliefs about Medicine Questionnaire on Medication Adherence: A Systematic Review. PHARMACY 2020; 8:pharmacy8030147. [PMID: 32824492 PMCID: PMC7559302 DOI: 10.3390/pharmacy8030147] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Medication adherence is a key determinant of patient health outcomes in chronic illnesses. However, adherence to long-term therapy remains poor. General beliefs about medicine are considered factors influencing medication adherence. It is essential to address the gap in the literature regarding understanding the impact of general beliefs about medicine on medication adherence to promote adherence in chronic illnesses. (2) Methods: PubMed, CINHAL, and EMBASE databases were searched. Studies were included if they examined medication beliefs using the Beliefs about Medicine Questionnaire in one of four chronic illnesses: hypertension, diabetes, chronic obstructive pulmonary disease, and/or asthma. (3) Results: From 1799 articles obtained by the search, only 11 met the inclusion criteria. Hypertension and diabetes represented 91% of included studies, while asthma represented 9%. Higher medication adherence was associated with negative general medication beliefs; 65% of the included studies found a negative association between harm beliefs and adherence, while 30% of studies found a negative association with overuse beliefs. (4) Conclusions: This review evaluated the impact of harm and overuse beliefs about medicines on medication adherence, highlighting the gap in literature regarding the impact of harm and overuse beliefs on adherence. Further research is needed to fully identify the association between general beliefs and medication adherence in people with different cultural backgrounds, and to explore these beliefs in patients diagnosed with chronic illnesses, particularly asthma and chronic obstructive pulmonary disease (COPD). Healthcare providers need to be aware of the impact of patients’ cultural backgrounds on general medication beliefs and adherence.
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Crilly P, Kayyali R. A Systematic Review of Randomized Controlled Trials of Telehealth and Digital Technology Use by Community Pharmacists to Improve Public Health. PHARMACY 2020; 8:E137. [PMID: 32759850 PMCID: PMC7559081 DOI: 10.3390/pharmacy8030137] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/31/2022] Open
Abstract
Community pharmacists (CPs) continue to have an important role in improving public health, however, advances in telehealth and digital technology mean that the methods by which they support their customers and patients are changing. The primary aim of this study was to identify which telehealth and digital technology tools are used by CPs for public health purposes and determine if these have a positive impact on public health outcomes. A systematic review was carried out using databases including PubMed and ScienceDirect, covering a time period from April 2005 until April 2020. The search criteria were the following: randomized controlled trials, published in English, investigating the delivery of public health services by community pharmacists using a telehealth or digital tool. Thirteen studies were included out of 719 initially identified. Nine studies detailed the use of telephone prompts or calls, one study detailed the use of a mobile health application, two studies detailed the use of a remote monitoring device, and one study detailed the use of photo-aging software. Public health topics that were addressed included vaccination uptake (n = 2), smoking cessation (n = 1), hypertension management (n = 2), and medication adherence and counseling (n = 8). More studies are needed to demonstrate whether or not the use of novel technology by CPs can improve public health.
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Affiliation(s)
| | - Reem Kayyali
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames KT1 2EE, UK;
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Salman M, Andrews C, Heisler M, Darnley-Fisch D, Newman-Casey PA. Psychosocial Predictors of Glaucoma Medication Adherence Among the Support, Educate, Empower (SEE) Personalized Glaucoma Coaching Pilot Study Participants. Am J Ophthalmol 2020; 216:207-218. [PMID: 32087145 DOI: 10.1016/j.ajo.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the association between baseline psychosocial milieu and subsequent glaucoma medication adherence among participants in the Support, Educate, Empower (SEE) personalized glaucoma coaching program pilot study. DESIGN Prospective cohort study. METHODS Participants (University of Michigan glaucoma patients aged ≥40 years, taking ≥1 glaucoma medication, who self-reported poor adherence) completed a baseline survey that assessed the following: (1) demographics; (2) social network; (3) perceived stress; (4) consideration of future consequences; (5) glaucoma-related distress; and (6) social support. Medication adherence was then monitored electronically for 3 months and the percentage of prescribed doses taken was calculated. The relationship between baseline factors and medication adherence was assessed using univariate and multivariate analysis. Main outcome measure was median percent adherence over 3 months. RESULTS Of the 95 study participants, 63% had graduated from college, 55% were white, 35% were African-American, and 97% had insurance. Median adherence over 3 months was 74% ± 21% (±standard deviation, SD). Higher income and more education were significantly associated with better adherence (P < .0001, P = .03). Glaucoma-related distress (mean score 5.6, SD = 3.0) was inversely associated with medication adherence on univariate (P < .0001) and multivariate analysis (P = .0002). Every 1-point increase in glaucoma-related distress score predicted a 2.4-percentage-point decrease in medication adherence. CONCLUSIONS Lower income, lower educational attainment, and a higher level of glaucoma-related distress all predicted lower adherence to glaucoma medications. Additional glaucoma self-management support resources should be directed toward patients with such risk factors for poor adherence.
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Affiliation(s)
- Mariam Salman
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Chris Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Deborah Darnley-Fisch
- Department of Ophthalmology and Visual Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA.
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67
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Huang YM, Shiyanbola OO, Chan HY, Smith PD. Patient factors associated with diabetes medication adherence at different health literacy levels: a cross-sectional study at a family medicine clinic. Postgrad Med 2020; 132:328-336. [PMID: 32233892 DOI: 10.1080/00325481.2020.1749499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) incurs tremendous health costs associated with various complications due to poor diabetes control. Medication adherence, which is correlated with patients' health literacy, should be consistently practiced achieving optimal diabetes control. A deeper understanding of the specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence. OBJECTIVES This cross-sectional study aimed to identify salient patient factors associated with diabetes medication adherence across different levels of health literacy. METHODS A questionnaire was administered via a face-to-face approach with 205 participants at a family medicine clinic. Study participants were all above 20 years of age with T2D, were prescribed at least one oral diabetes medication, and understood English. The questionnaire assessed participants' health literacy, self-efficacy for medication use, beliefs in medicines, patient-provider communication, perceived barriers to medication adherence, and self-reported medication adherence. Separate analysis of covariance was used to compare the mean scores of patient factors related to medication adherence across people with different health literacy levels. RESULTS The mean age of participants was 61 years old, and the majority of the participants were female (57%), White (75%), and college educated (62%). Thirty-three percent of the participants had adequate health literacy, but only 43% of them reported high adherence to their diabetes medications. Analysis of covariance showed that having stronger self-efficacy (P < 0.001), lower concern beliefs about medication (P = 0.047), and fewer perceived barriers to medication-taking (P < 0.001), are necessary for better medication adherence. CONCLUSION Findings suggest that practitioners should address concern beliefs among low-adherent patients with low health literacy, help improve self-efficacy, and address perceived barriers to medication adherence among all low-adherent patients to optimally support patients' diabetes care.
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Affiliation(s)
- Yen-Ming Huang
- College of Pharmacy and Allied Health Professions, South Dakota State University , Brookings, SD, USA.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University , Taipei City, Taiwan
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison , Madison, WI, USA
| | - Hsun-Yu Chan
- Department of Psychology and Special Education, Texas A&M University , Commerce, TX, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, University of Wisconsin-Madison , Madison, WI, USA
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Ting CY, Ahmad Zaidi Adruce S, Lim CJ, Abd Jabar AHA, Ting RSK, Ting H, Osman NA, Ngau E, Talin BA, Muhammad M, Loo SC, Lim SE, Hassali MA. Effectiveness of a pharmacist-led structured group-based intervention in improving medication adherence and glycaemic control among type 2 diabetes mellitus patients: A randomized controlled trial. Res Social Adm Pharm 2020; 17:344-355. [PMID: 32327398 DOI: 10.1016/j.sapharm.2020.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A pharmacist-led structured group-based intervention (MEDIHEALTH) was formulated to improve medication adherence among Malay type 2 diabetes mellitus (T2DM) patients in the Malaysian state of Sarawak. OBJECTIVES The objective of this study was to examine the effectiveness of MEDIHEALTH and its mechanism of impact for improving medication adherence and the glycated haemoglobin (HbA1c) level. METHODS A two group and parallel randomised controlled trial with a twelve months follow-up period was conducted at two primary health clinics in Malaysia that were surrounded by Malay communities. Malay T2DM patients whose HbA1c was >7% and total score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was <26 were recruited and parallelly randomised to the MEDIHEALTH or usual care (control) groups. The extended theory of planned behaviour was employed to test the mechanism of impact. Repeated measure analysis of variance was used to assess the difference in the estimated marginal mean of the SEAMS scores and HbA1c level between the intervention and control groups at different times. RESULTS A total of 142 participants were recruited and randomised; three from the intervention group and eight from the control group withdrew before receiving any treatment. Hence, 68 participants in the intervention group and 63 in the control group were included for analyses. The MEDIHEALTH group had a significantly greater increase in the SEAMS score compared to the control group (p < 0.001) at one, three, six and twelve months post-intervention. There was also a significantly greater reduction in HbA1c in the MEDIHEALTH compared to the control group at one, three, six and twelve months post-intervention (p < 0.001). These improvements were mediated by enhancements in perceived behavioural control and knowledge about medications. CONCLUSIONS The MEDIHEALTH may improve medication adherence and glycaemic control among Malay T2DM patients.
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Affiliation(s)
- Chuo Yew Ting
- Institute of Borneo Studies, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia; Pharmacy Practice and Development Division, Sarawak State Health Department Sarawak, Minitry of Health, Malaysia.
| | - Shahren Ahmad Zaidi Adruce
- Institute of Borneo Studies, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia; Faculty of Cognitive Science and Human Development, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Chien Joo Lim
- Clinical Research & Innovation Office, Tan Tock Seng Hospital, Singapore.
| | | | - Rachel Sing-Kiat Ting
- Monash University, Jeffrey Cheah School of Medicine and Health Sciences, Selangor, Malaysia.
| | - Hiram Ting
- Sarawak Research Society, Sarawak, Malaysia; Faculty of Hospitality and Tourism Management, UCSI University, Malaysia.
| | - Nor Anizah Osman
- Pharmacy Practice and Development Division, Sarawak State Health Department Sarawak, Minitry of Health, Malaysia.
| | - Esther Ngau
- Pharmacy Department, Petra Jaya Health Clinic, Petra Jaya, Kuching, Ministry of Health, Malaysia.
| | - Benodict Apok Talin
- Pharmacy Enforcement Division, Sarawak State Health Department Sarawak, Ministry of Health, Malaysia.
| | - Munira Muhammad
- Pharmaceutical Services Division, Ministry of Health, Malaysia.
| | - Shing Chyi Loo
- Pharmacy Enforcement Division, Sarawak State Health Department Sarawak, Ministry of Health, Malaysia.
| | - Su Ee Lim
- Pharmacy Practice and Development Division, Sarawak State Health Department Sarawak, Minitry of Health, Malaysia.
| | - Mohamed Azmi Hassali
- Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
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Brewster S, Holt R, Portlock J, Price H. The role of community pharmacists and their position in the delivery of diabetes care: an update for medical professionals. Postgrad Med J 2020; 96:473-479. [PMID: 32217748 DOI: 10.1136/postgradmedj-2020-137511] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 11/04/2022]
Abstract
Pharmacists are the third largest group of healthcare professionals worldwide, but are underused in the delivery of diabetes care. The aim of this narrative was to describe how integration of community pharmacy services into existing healthcare models may improve diabetes care. Relevant literature exploring pharmacy-led interventions for diabetes were identified from a search of Medline, Embase and Cinahl online databases. This review highlights that community pharmacists are accessible, experts in medicine management, trusted by the public and able to achieve financial savings. They are poorly integrated into existing healthcare models, and commissioning arrangements can be poorly perceived by the public and those working in primary care. Community pharmacy interventions in type 2 diabetes have similar, if not greater effects compared to those delivered by other healthcare professionals. It was concluded that community pharmacy interventions in diabetes are feasible, acceptable and deliver improved health outcomes. Future work should build public recognition of pharmacists and improve communication between them and other healthcare professionals.
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Affiliation(s)
- Sarah Brewster
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Richard Holt
- Division of Human Development and Health, University of Southampton, Southampton, UK
| | - Jane Portlock
- School of Life Sciences, University of Sussex, Brighton, UK
| | - Hermione Price
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
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70
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Jang S, Han E, Kang C, Cho HM, Sohn HS, Lee JY. Assessment of a medication management program targeting hypertension and diabetes patients: Impact on medication adherence. Res Social Adm Pharm 2020; 17:419-427. [PMID: 32197921 DOI: 10.1016/j.sapharm.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The National Health Insurance Service in South Korea has conducted a telephone outreach program to improve medication adherence for hypertension and diabetes patients since 2014. OBJECTIVES To evaluate the direct outcomes of the program. METHODS Patients were identified among those who visited an outpatient clinic at least twice or used an inpatient service at least once for hypertension or diabetes during 6-month intervals and who were nonadherent based on the proportion of days covered (PDC) calculated. As a preliminary intervention, participants were mailed an information leaflet on their own medication adherence and other tips for effective self-management of chronic diseases. For the intervention, two phone calls and three phone messages were made to patients by 24 participating regional offices. Ultimately, 2,428 hypertension patients and 884 diabetes patients received the intervention. Propensity matching was used based on age, sex, and the Charlson Comorbidity Index to select 12,140 hypertension and 4,420 diabetes patients as controls in the non-participating regions. The outcome was PDC. Multivariate ordinary least squares or logistic regression analysis were used with difference-in-difference specification. RESULTS The adjusted quarterly PDC increased by 1.96%p for hypertension (p = 0.023) and by 7.79%p for diabetes patients (p < 0.001). Approximately 40.6% and 51.7% of hypertension and diabetes patients in the treatment arm (p = 0.0069) became adherent after the intervention, whereas the corresponding proportions were 37.7% and 41.4% (p < 0.001) in the control group. Both treatment groups showed a higher likelihood of good medication adherence (hypertension: odds ratio = 1.157, 95% CI [1.058, 1.265]; diabetes: odds ratio = 1.532, 95% CI [1.323, 1.774]). The control group, who received only a print intervention with a mailed leaflet, also showed a dramatic increase in medication adherence. CONCLUSIONS An insurer-coordinated telephone-administered program resulted in improvement of medication adherence among patients with hypertension and diabetes.
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Affiliation(s)
- Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Incheon, Gachon University, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Incheon, Yonsei University, South Korea.
| | - Cinoo Kang
- Graduate School of Public Health, Seoul, Seoul National University, South Korea
| | - Hye-Min Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Incheon, Gachon University, South Korea
| | - Hyun Soon Sohn
- College of Pharmacy, Bundang, CHA University, South Korea
| | - Ju-Yeun Lee
- College of Pharmacy, Seoul, Seoul National University, South Korea
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71
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Yin D, Guo Q, Geng X, Song Y, Song J, Wang S, Li X, Duan J. The effect of inpatient pharmaceutical care on nephrotic syndrome patients after discharge: a randomized controlled trial. Int J Clin Pharm 2020; 42:617-624. [PMID: 32170589 DOI: 10.1007/s11096-020-00975-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/18/2020] [Indexed: 12/16/2022]
Abstract
Background Clinical pharmacists can play an important role in chronic diseases management, but limited attention has been given to the pharmaceutical care of nephrotic syndrome patients. Objective To evaluate the impact of inpatient pharmaceutical care on medication adherence and clinical outcomes in nephrotic syndrome patients. Setting A tertiary first-class hospital in Shanxi, China. Method We conducted a randomized controlled trial on 61 patients with nephrotic syndrome. The intervention consisted of medication reconciliation, pharmacist visits every day, discharge counseling and education by 2 certificated pharmacist, while the control group received usual care. Assessments were performed at baseline, month-1, month-3 and month-6 after hospital discharge. Main outcome measure medication adherence and patients' clinical outcomes. Results 61 patient completed the trial. Baseline variables were comparable between the two groups. The decline in medication adherence of patients in the intervention group after hospital discharge was restrained effectively at month-6 (p < 0.05). However, the groups did not differ in clinical outcomes, medication discrepancies, adverse drug events and readmission rate. The rate of return visits of the pharmaceutical care group was higher at month-1 and month-6 after discharge (p < 0.05). Conclusion Pharmaceutical inpatient care improved adherence in patients with nephrotic syndrome after hospital discharge, the effect of the intervention on clinical outcomes, medication discrepancies, adverse drug events or readmission was insignificant. These results are promising but should be tested in other settings prior to broader dissemination.
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Affiliation(s)
- Donghong Yin
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi, China
| | - Qian Guo
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi, China
| | - Xin Geng
- Department of Pharmacy, Beijing Luhe Hospital Capital Medical University, Beijing, China
| | - Yan Song
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi, China
| | - Junli Song
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi, China
| | - Shuyun Wang
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi, China
| | - Xiaoxia Li
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi, China
| | - Jinju Duan
- Department of Pharmacy, Second Hospital of Shanxi Medical University, No. 382, Wuyi Road, Taiyuan, Shanxi, China.
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Parente M, Pignata I, Gnavi R, Spadea T, Di Martino M, Baratta F, Brusa P. Assessment of Non-Adherence to Oral Metformin and Atorvastatin Therapies: A Cross-Sectional Survey in Piedmont (Italy). Patient Prefer Adherence 2020; 14:261-266. [PMID: 32103910 PMCID: PMC7028384 DOI: 10.2147/ppa.s226206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/16/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION It is not possible to recover from chronic diseases; however, a healthy lifestyle and correct adherence to therapy can avoid complications and co-morbidities. The aim of this study was the cross-sectional evaluation, by means of a questionnaire, of real-world data on the prevalence of non-adherence to metformin and atorvastatin oral therapies in a sample of patients that attend community pharmacies in the Piedmont Region. The secondary aim was to evaluate the presence of correlations between non-adherence and a number of variables detected by the questionnaire. MATERIALS AND METHODS Data were gathered from face-to-face interviews in six community pharmacies in Piedmont. The questionnaire was divided into two sections: the first included the Morisky, Green and Levine Medication Adherence Questionnaire (MAQ) (to assess therapy adherence); the second included questions on gender, age, level of education and the pharmacy in which the questionnaire was administered. Comparisons between proportions and mean values were performed using the χ2 test. Modified Poisson regression with robust standard errors was used for multivariate analysis. The level of significance was fixed at 0.05, CI at 95%. RESULTS The sample analysed was composed of 408 subjects (receiving either metformin or atorvastatin). According to MAQ, 62 patients were non-adherent (15% of the total cohort). Crude and multivariate analysis did not show any statistically significant correlation between gender, age, level of education and non-adherence. It emerged that there was a correlation between non-adherence and being a customer of two of the pharmacies involved [PR = 3.31 (p=0.028) and PR = 3.11 (p=0.027)]. CONCLUSIONS Community pharmacies can be an appropriate setting to identify non-adherent patients. Therefore, healthcare professionals could realize an integrated and structured intervention to improve adherence. However, MAQ could underestimate the number of non-adherent patients. Further studies to test the association between non-adherence prevalence and being the customer of a specific pharmacy should be performed.
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Affiliation(s)
- Marco Parente
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Irene Pignata
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | | | | | - Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
- Correspondence: Paola Brusa Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, Turin10125, ItalyTel +39 011 670 66 65 Email
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Nasution A, Dalimunthe A, Khairunnisa K. Pharmacists Intervention Reduced Drug-Related Problems in the Treatment of Patients with Type 2 Diabetes Mellitus. Open Access Maced J Med Sci 2019; 7:3856-3860. [PMID: 32127991 PMCID: PMC7048351 DOI: 10.3889/oamjms.2019.519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: Type 2 Diabetes Mellitus (T2DM) remains as a global public health problem, including Indonesia due to its continuous increasing prevalence. AIM: To analyze the impact of pharmacist intervention on drug-related problems (DRPs) occurred in the management of patients with T2DM admitted to Tebing Tinggi Hospital (TTH), Indonesia, period March through August 2018. METHODS: This six-month retrospective prospective cohort study evaluated the impact of pharmacist intervention on the occurrence of DRPs in the management of patients with T2DM (n = 45) insured by Social Security Organizing Body in TTH, North Sumatera, Indonesia. The inclusion criteria were T2DM patients with age ≥ 18 years and under treatment of antidiabetic drugs. A questionnaire was used to assess the characteristics of the patients and antidiabetic drugs provided. The incidence of DRPs in groups with usual care for the previous three-month and with pharmacist interventions for the next three-month admissions were analyzed using Pharmaceutical Care Network Europe (PCNE) DRP classification system version 8.01 that consists of 3 primary domains for problems, 8 primary domains for causes, and 5 primary domains (PCNE, 2017) and trustable literatures. The obtained data were analyzed using descriptive statistics and paired t test in the program of Statistical Package for the Social Sciences version 19 (p < 0.05 was considered significant). RESULTS: Most (66.7%) of the patients were female. Their mean age was 61.96 ± 6.45 (years). The three most widely provided drugs were metformin, glimepirid, and gliclazide. Total incidence of DRPs in groups with: usual care, 128; intervention, 39. There was a significant difference between the incidence of DRPs in groups with usual care and intervention, p ≤ 0.001. CONCLUSION: Pharmacist intervention reduced the incidence of DRPs in the management of T2DM patients.
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Affiliation(s)
- Azizah Nasution
- Department of Pharmacology, Faculty Pharmacy, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Aminah Dalimunthe
- Department of Pharmacology, Faculty Pharmacy, Universitas Sumatera Utara, Medan 20155, Indonesia
| | - Khairunnisa Khairunnisa
- Department of Pharmacology, Faculty Pharmacy, Universitas Sumatera Utara, Medan 20155, Indonesia
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Witry M, Ernzen M, Pape A, Viyyuri BR. Pilot and Feasibility of Combining a Medication Adherence Intervention and Group Diabetes Education for Patients with Type-2 Diabetes. PHARMACY 2019; 7:E76. [PMID: 31261613 PMCID: PMC6789893 DOI: 10.3390/pharmacy7030076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction: Controlling diabetes typically requires self-management and medications. Community pharmacists are positioned to support patients with both. Methods: This study assessed the feasibility and potential benefit of combining pharmacist-provided group diabetes education (up to eight sessions) and medication synchronization using a three-group design. Data were collected using pre-post paper surveys and electronic health record data. One group received both education and synchronization services, another group received medication synchronization only, and a third served as control. Results: Of 300 contacted patients, eighteen patients participated in group diabetes education, 14 had medication synchronization only, and 12 comprised a control group. There was little change in HbA1c over the study period. Medication adherence appeared to be positively aided by medication synchronization, although all groups started with high adherence. Some medication beliefs and self-care activities may have been positively impacted by group diabetes education. Both groups receiving medication synchronization were satisfied. Conclusions: Participants strongly agreed they would recommend group diabetes education from the study pharmacy to a friend and were satisfied with medication synchronization; however, it was difficult to tell if there was a synergistic effect by combining the two services. Reimbursement for diabetes education was not obtained despite multiple attempts, hindering sustainability.
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Affiliation(s)
- Matthew Witry
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA.
| | | | | | - Brahmendra Reddy Viyyuri
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA
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