The influence of pharmacist-led adherence support on glycaemic control in people with type 2 diabetes

"It's just like putting your socks on": patients' perspectives on inflammatory bowel disease medication adherence

Background

A careful, often life-long, medication regimen is central to therapy for Inflammatory Bowel Disease (IBD) - a chronic gut disorder. Hence, medication adherence (MA) - patients taking medications in line with prescription - is important. Previous research indicates that a third of patients with IBD in southern New Zealand have poor medication adherence (MA).

Objective

This study investigated these patients' experiences to determine factors that influence their MA, for the first time.

Methods

Two focus group discussions (FGDs) were held with IBD patients in Otago, New Zealand. Reflexive thematic analysis from a 'direct realist' viewpoint was used to analyse the data.

Results

Data were analysed in three segments: perceptions, experiences and support. Participants perceived MA as a "duty" that was very important to their wellbeing. The participants' MA was centred around a routine requiring proactivity to maintain. MA was negatively impacted by side effects and regimen factors including (high) pill numbers/dose frequency, and getting refills was framed as challenging; whilst healthcare professionals were presented as major MA facilitators. Lastly, the support structures identified included family, friends and colleagues as well as targeted health system factors e.g. medication subsidies.

Conclusions

Factors spanning those related to the patients, their socioeconomic status, the disease, IBD therapy and the health system were presented as influencing IBD patients' MA in southern NZ. Thus, multifaceted interventions are needed across the health system to overcome the inhibiting and promote the facilitating elements.

Type 2 Diabetes Patients' Views of Local Pharmacists and Fulfilment with Pharmaceutical Diabetes Care in Syria's Latakia Governorate: An Online Survey Research

Assessing the attitudes of diabetic patients towards community-pharmacy services and determining the demand for new services could help monitor and evaluate the therapeutic response. This study aimed to evaluate type 2 diabetes patients' satisfaction regarding pharmacy care in community pharmacies and shed a light on the reasons for diabetic patients' non-adherence to treatments. An online survey was conducted on a random sample of patients (n = 196) at the national Diabetes Centre in Latakia, Syria, from April to November 2022. The questionnaire consisted of four primary parts: (1) demographic characteristics of responders, (2) patients' therapeutic behaviors, (3) diabetes knowledge, and (4) the general level of satisfaction with pharmacy diabetes services. The data were analyzed using descriptive analysis. Around 89% of respondents were satisfied with the information provided by community pharmacists. The patients' non-adherence showed a maximum as a function of the number of concomitantly taken medicines, which indicated that in most serious cases patients' adherence was increasing. Overall, most patients were delighted with community pharmacists' expertise and pharmacy services. This positive image allows pharmacists to expand their duties as healthcare providers in diabetes care, and increase the patient therapeutic adherence by performing a reconciliation of the patient's medicines, which involves reviewing all patients' drugs and identifying realistic solutions to their adherence issues.

The Effect of Interventions Led by Community Pharmacists in Primary Care for Adults with Type 2 Diabetes Mellitus on Therapeutic Adherence and HbA1c Levels: A Systematic Review

Type 2 diabetes mellitus has been assessed as a widespread disease globally. Unfortunately, this illness can occasionally go undetected and without symptoms until it reaches the emergency condition, and this can be notably true in patients who do not receive routine medical care. Pharmacists are the foremost accessible health care providers. They can help patients select the most appropriate hypoglycemic management strategy through their experiences. This review aimed to provide an overview of the literature published on community pharmacists' interventions that are currently used and their usefulness in improving patient adherence and glycosylated hemoglobin (HbA1c) levels. Relevant studies were retrieved through a comprehensive search of three databases, PubMed/Medline, Web of Science, and CINAHL (2010 to 2020). In total, 8362 publications were identified. The final protocol was based on the "Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)". After applying inclusion and exclusion measures, 21 articles were deemed relevant. In pharmacists' interventions in diabetes care, patient education and counseling were the most common intervention methods. Essentially, this systematic review provides evidence and identifies the key features that may predict success in enhancing clinical outcomes and patient adherence to treatment. Based on our findings, we suggest further investigations of the root causes of non-adherence problems.

The first nationwide implementation of pharmaceutical care practices through a continuing professional development approach for community pharmacists

BACKGROUND

Noncommunicable diseases account for the majority of all deaths and impose a high socioeconomic burden, causing disability and premature deaths. Pharmacists can contribute to the prevention and management of these diseases through the provision of pharmaceutical care services.

AIM

The aim of this study was to implement a nationwide practice developed by the Turkish Pharmacists' Association aiming to realize pharmaceutical care provision of standard quality to patients with asthma, chronic obstructive pulmonary disease, diabetes and hypertension at community pharmacies through a continuing professional development approach.

SETTING

Community pharmacies in Turkey.

DEVELOPMENT

A project with the involvement of all community pharmacists who were willing to participate was developed. After piloting, the 'project' turned into a 'practice' with a focus on asthma, chronic obstructive pulmonary disease, diabetes and hypertension management.

IMPLEMENTATION

The training process occurred as a peer-training activity. Consultants and academic staff trained the trainer pharmacists during a 3-day course. Community pharmacists (n = 6161) received training regarding pharmaceutical care, asthma, chronic obstructive pulmonary disease, diabetes and hypertension from their peer trainers (n = 341) and began to practice pharmaceutical care and follow-up of patients' outcomes on a regular basis.

EVALUATION

Among all community pharmacists in Turkey (n = 26,177), 24% attended training. Among these pharmacists, 21% started to implement practice. With community pharmacists' contribution to patient care, significant improvements in the majority of the outcome parameters regarding asthma, chronic obstructive pulmonary disease, diabetes and hypertension management were noted.

CONCLUSION

This first nationwide practice showed us that community pharmacists can help improve the health outcomes of patients with asthma, chronic obstructive pulmonary disease, diabetes and hypertension through the provision of pharmaceutical care services.

A physician-pharmacist collaborative care model to prevent opioid misuse

PURPOSE

Clinical pharmacists in primary care clinics can potentially help manage chronic pain and opioid prescriptions by providing services similar to those provided within their scope of practice to patients with diabetes and hypertension. We evaluated the feasibility and acceptability of a pharmacist-physician collaborative care model for patients with chronic pain.

METHODS

The program consisted of an in-person pharmacist consultation and optional follow-up visits over 4 months in 2 primary care practices. Eligible patients had chronic pain and a long-term prescription for opioids or buprenorphine or were referred by their primary care physician (PCP). Pharmacist recommendations were communicated to PCPs via the electronic medical record (EMR) and direct communication. Mixed-methods evaluation included baseline and follow-up surveys with patients, EMR review of opioid-related clinical encounters, and provider interviews.

RESULTS

Between January and October 2018, 47 of the 182 eligible patients enrolled, with 46 completing all follow-up; 43 patients (91%) had received opioids over the past 6 months. The pharmacist recommended adding or switching to a nonopioid pain medication for 30 patients, switching to buprenorphine for pain and complex persistent opioid dependence for 20 patients, and tapering opioids for 3 patients. All physicians found the intervention acceptable but wanted more guidance on prescribing buprenorphine for pain. Most patients found the intervention helpful, but some reported a lack of physician follow-up on recommended changes.

CONCLUSION

The study demonstrated that comanagement of patients with chronic pain is feasible and acceptable. Policy changes to increase pharmacists' authority to prescribe may increase physician willingness and confidence to carry out opioid tapers and prescribe buprenorphine for pain.

Medicines use review service in community pharmacies in Spain: REVISA project

Background Community pharmacy services play an important role in controlling some factors related to medicine use and patients can benefit from these services to improve the adherence and knowledge of their medications, besides to reduce medicine-related problems. Objective The aim of the REVISA project is to carry out a study on preliminary implementation of the medicines use review service in Spanish community pharmacies. Setting Sixty-four community pharmacies from all regions of Spain. Method A preliminary implementation, cross-sectional multicentre study was conducted using a convenience sample of voluntary community pharmacies. A structured interview enabled to pharmacists to obtain a better understanding of patient's medicines use. Main outcome measure Medicines use review-related time and cost, satisfaction and willingness to pay. Results A total of 495 patients were enrolled. The mean age of the patients was 66.1 years, with the majority females (56.4%) and a mean consumption of 5.7 medicines. A total of 2811 medicines were evaluated and 550 referral recommendations were made (29.8% to Primary Care). The mean time employed by the pharmacists in the medicines use review service was 52.8 min (medicines use review-related cost of €17.27). Most patients expressed a high level of satisfaction with this service (98.5%) and a willingness to pay for it (84%). Conclusion Medicines use review service in community pharmacies in Spain can be delivered, that it appears to be acceptable to patients and that most patients said they would be willing to pay for it. This service may offer an opportunity to promote inter-professional collaboration between pharmacists and general practitioners.

Expanding Pharmacy Services With an Intern Program at an Academic Medical Center

BACKGROUND

Organizations that implement pharmacy services to provide patient education have reduced hospital readmissions and improved the patient experience. The term "pharmacy extender" has been used to describe pharmacy technicians and pharmacy students who alleviate the workload of a pharmacist, enhance pharmacy visibility throughout an organization, and foster professional development for the individual.

OBJECTIVE

The objective of this pharmacy intern-driven program is to increase pharmacy reach for medication teaching.

METHODS

This is a single-center, IRB-approved retrospective cohort analysis. Pharmacist-led medication teaching is currently available to select high-risk populations including solid organ transplant and bone marrow transplant recipients at our organization. Clinicians working in the pharmacy satellites have structured operational and distributional workflow responsibilities, which precludes them from directly engaging with patients. Pharmacy interns can serve as extenders that can participate in medication teaching. An internally created digital medication teaching tool will be employed to expand the pharmacy reach for medication education.

RESULTS

During the period of study, the pharmacy interns screened 3,993 patients and educated 2,868 patients. Two-thirds of the pharmacy interns that participated in the program pursued post-graduate residency or fellowship training, while the rest assumed hospital pharmacist positions.

CONCLUSION

Deploying pharmacy interns as extenders for distribution of an internally created digital tool that provides general medication teaching has shown positive outcomes including greater pharmacy presence and visibility, better patient experience, and higher patient satisfaction. Continuous data collection and monitoring are warranted to demonstrate the benefits of the program once sustained and potentially justify more resources for further expansion.

Caring for patients with diabetes during COVID-19 pandemic: Important considerations for pharmacists

The current pandemic of the COVID-19 infection, coupled with the increased global burden of diabetes, has imposed significant challenges to the healthcare providers in providing effective and sustained care to patients with diabetes during the ongoing pandemic. It is, therefore, important for healthcare providers to understand and follow the recommended changes in the delivery of care, lifestyle modifications, and pharmacotherapy to ensure optimal care to the patients during and post-pandemic era. This commentary aims to discuss the impact of COVID-19 on diabetes care and the important considerations for pharmacists during this pandemic.

Beating non-communicable diseases in primary health care: The contribution of pharmacists and guidance from FIP to support WHO goals

According to the World Health Organization (WHO), more than 36 million people die annually from non-communicable diseases (NCDs), representing over 60% of deaths worldwide, 15 million of which occur before the age of 70 years. Prevention and control of NCDs and their risk factors require interventions that are therapeutically cost-effective, affordable by the patient and/or health systems and feasible, based upon local resources. This commentary paper sets a basis of global evidence to advocate, nationally and internationally, for an expanded role for pharmacists in NCD management by compiling best practices and examples. It encourages pharmacists around the world to act upon NCDs, from prevention and screening activities, to patient referral when appropriate, and to pharmacist-led, patient-centred NCD management to improve outcomes and quality of life. Priority NCDs fall into four areas: cardiovascular diseases, diabetes, asthma/chronic obstructive pulmonary disease and cancer. Building on the key roles they already play as primary healthcare professionals in the community, pharmacists can provide focused interventions, specialised counselling and care coordination, improving patient engagement to achieve better outcomes in the global fight against NCDs.

A systematic review of pharmacist-led medicines review services in New Zealand - is there equity for Māori older adults?

BACKGROUND

Pharmacist involvement in medicines reviews for older adults can improve prescribing and reduce adverse drug reactions. Māori experience poorer health outcomes than non-Māori resulting, in part, from inequitable access to and quality of medicine-related care. Despite international data showing benefit, it is unclear whether pharmacist-led medicines review services can improve outcomes for Māori older adults.

OBJECTIVE

This systematic review aims to describe pharmacist-led medicines review services for community-dwelling adults in New Zealand, assess effectiveness of these interventions and identify their effect on health equity for Māori and older adults.

METHODS

The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Equity (PRISMA-E 2012). Observational studies were included. The intervention in included studies had to involve a pharmacist, occur in the outpatient setting in New Zealand, and involve review of all medicines for an individual patient. At least one patient-related outcome had to be reported.

RESULTS

The search identified seven observational studies with 542 total participants. Study interventions included adherence-based reviews in community pharmacies and multi-step comprehensive clinical reviews in outpatient haemodialysis units. Medicines reviews identified up to a median of 3 drug-related problems per review. The effect of interventions on medicines adherence and knowledge was not clear. Māori may have been less likely than non-Māori to benefit from improved medicines knowledge as a result of interventions. None of the studies incorporated aspects in study design or delivery to address inequities for Māori.

CONCLUSION

Further investigation is needed to understand whether the development of culturally safe pharmacist-led medicines review services, responsive to community identified needs, can help to achieve equity in health outcomes for Māori older adults.

Using the Pharmaceutical Collection Database to identify patient adherence to oral hypoglycaemic medicines

ABSTRACT INTRODUCTIONPoor adherence to oral hypoglycaemic medicines is a key contributor to therapy failure and sub-optimal glycaemic control among people with type 2 diabetes. It is unclear how commonly non-adherence to oral hypoglycaemics occurs in the general population. This information is essential to design and implement local adherence strategies. AIMThis study aimed to determine levels of sub-optimal adherence and identify patient groups who may need additional adherence support. METHODSThe dispensing data of 340,283 patients from one District Health Board was obtained from the Pharmaceutical Collection Database for the period 2008–15. Of these, 12,405 patients received oral hypoglycaemic therapy during the study period. The proportion of days covered (PDC) was calculated for patients with complete data and a PDC value of ≥80% was used to indicate sufficient adherence. Patient demographics (gender, ethnicity, age, socioeconomic status) and therapy type (mono- or combination) were described. RESULTSOverall, 54.5% of the patients were found to have a PDC of <80% and so were considered non-adherent. Non-adherence was significantly higher in patients receiving combination oral hypoglycaemic therapy than monotherapy; in male patients; in New Zealand Māori patients; and in patients with higher socioeconomic deprivation. DISCUSSIONIn the study region, non-adherence to oral hypoglycaemic medicines was significant and widespread. Identification of such patients is important so that strategies to enhance adherence can be implemented. Prescribers need to be encouraged to optimise monotherapy before the addition of another oral hypoglycaemic, and adherence support services should be offered not only to older patients.