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Thepwongsa I, Muthukumar R, Sripa P, Piterman L. Uptake and effectiveness of online diabetes continuing education: The perspectives of Thai general practitioner trainees. Heliyon 2023; 9:e13355. [PMID: 36755621 PMCID: PMC9900372 DOI: 10.1016/j.heliyon.2023.e13355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Background Despite continuing medical education (CME) programmes on evidence-based diabetes care, evidence-based best practice and actual GP practice remain scant. Online CME offers numerous benefits to general practitioners (GPs), particularly during the coronavirus disease 2019 (COVID-19) pandemic. In Thailand, CME is a voluntary process and is yet to be established as a mandatory requirement. This study examined GP uptake of online diabetes CME and the changes in GPs' attitudes to and knowledge of Type 2 diabetes management. Methods A cross-sectional study and a before-and-after study were employed with 279 GP trainees who voluntarily undertook a newly-developed online diabetes programme. A follow-up survey was conducted six months after the GP trainees completed their training. Results One hundred and twelve out of 279 GP trainees (40.1%) participated in the study, of whom 37 (13.3%) enrolled in the online diabetes programme, and 20 (7.2%) completed the programme. Before enrolling in the programme, the participants' mean diabetes knowledge score was 61.5%. The participants' confidence in effective insulin treatment increased significantly after the programme (95% Confidence interval [CI], -0.51-0.00; P = 0.05), but their knowledge scores before and after the programme were not statistically different (95% CI, -3.93-0.59; P = 0.14). Conclusion Uptake of the online diabetes CME was poor, although appropriate recruitment strategies were employed, and the online educational option was attractive and accessible during the COVID-19 pandemic. This study emphasises the gap between evidence-based practice and actual GP practice and the need for mandatory CME.
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Affiliation(s)
- Isaraporn Thepwongsa
- Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand,Corresponding author. Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen province, 40002, Thailand.
| | | | - Poompong Sripa
- Medicine for the Elderly Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Leon Piterman
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Australia
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2
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Evans M, Engberg S, Faurby M, Fernandes JDDR, Hudson P, Polonsky W. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review. Diabetes Obes Metab 2022; 24:377-390. [PMID: 34779107 PMCID: PMC9299643 DOI: 10.1111/dom.14603] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 12/28/2022]
Abstract
We designed a systematic literature review to identify available evidence on adherence to and persistence with antidiabetic medication in people with type 2 diabetes (T2D). Electronic screening and congress searches identified real-world noninterventional studies (published between 2010 and October 2020) reporting estimates of adherence to and persistence with antidiabetic medication in adults with T2D, and associations with glycaemic control, microvascular and/or macrovascular complications, hospitalizations and healthcare costs. Ninety-two relevant studies were identified, the majority of which were retrospective and reported US data. The proportions of patients considered adherent (median [range] 51.2% [9.4%-84.3%]) or persistent (median [range] 47.7% [16.9%-94.0%]) varied widely across studies. Multiple studies reported an association between greater adherence/persistence and greater reductions in glycated haemoglobin levels. Better adherence/persistence was associated with fewer microvascular and/or macrovascular outcomes, although there was little consistency across studies in terms of which outcomes were improved. More adherent and more persistent patients were typically less likely to be hospitalized or to have emergency department visits/admissions and spent fewer days in hospital annually than less adherent/persistent patients. Greater adherence and persistence were generally associated with lower hospitalization costs, higher pharmacy costs and lower or budget-neutral total healthcare costs compared with lower adherence/persistence. In conclusion, better adherence and persistence in people with T2D is associated with lower rates of microvascular and/or macrovascular outcomes and inpatient hospitalization, and lower or budget-neutral total healthcare expenditure. Education and treatment strategies to address suboptimal adherence and persistence are needed to improve clinical and economic outcomes.
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Affiliation(s)
- Marc Evans
- Department of Diabetes and EndocrinologyUniversity Hospital LlandoughPenarthUK
| | | | | | | | | | - William Polonsky
- Behavioral Diabetes InstituteSan DiegoCaliforniaUSA
- Department of MedicineUniversity of CaliforniaSan DiegoCaliforniaUSA
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3
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Sainsbury E, Shi Y, Flack J, Colagiuri S. The diagnosis and management of diabetes in Australia: Does the "Rule of Halves" apply? Diabetes Res Clin Pract 2020; 170:108524. [PMID: 33164851 DOI: 10.1016/j.diabres.2020.108524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 01/17/2023]
Abstract
The Rule of Halves (ROH) is a theoretical framework which states that roughly half of all people with a condition are diagnosed; half of those diagnosed receive care; half of those who receive care achieve their treatment targets; and half of those who reach their targets achieve the desired treatment outcomes. This review examined the applicability of the ROH to diabetes in Australia. Five databases were searched for articles and government reports published between January 2000 and August 2019. Data was extracted for each level of the framework, and pooled sample proportions calculated for the total population and sub-group analysis by ethnicity and type of diabetes. The results showed that 72% of people with diabetes are diagnosed. Approximately 50% are receiving standard care, and 40-60% are meeting treatment targets for HbA1c, blood pressure and lipid levels. Overall, Australia is doing better than the ROH when it comes to achieving treatment outcomes; prevalence of microvascular complications was 20-30% and cardiovascular disease 62%. Indigenous people were less likely to meet treatment targets and more likely to experience adverse complications of diabetes. This review indicates the ROH does generally apply for diabetes care and management in Australia, highlighting the need for further improvement.
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Affiliation(s)
- Emma Sainsbury
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
| | - Yumeng Shi
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
| | - Jeff Flack
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney NSW, Australia.
| | - Stephen Colagiuri
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
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4
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Yao J, Wang H, Yin J, Shao D, Guo X, Sun Q, Yin X. Factors associated with the utilization of community-based diabetes management care: A cross-sectional study in Shandong Province, China. BMC Health Serv Res 2020; 20:407. [PMID: 32393254 PMCID: PMC7212576 DOI: 10.1186/s12913-020-05292-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 05/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background Community-based diabetes management is known to be an important strategy for global diabetes control. In China, community-based diabetes management care, including regular blood glucose tests and guidance on medicine use, dietary control, and physical exercise provided by primary health institutions (PHIs), as one of the key contents of the national essential public health services (EPHS), was implemented since 2009 when the new round of health system reform was initiated. This study aimed to investigate the utilization of community-based diabetes management care services, and explore the factors influencing utilization from both patients’ and providers’ points of view. Methods In total, 2520 type-2 diabetes mellitus (DM) patients registered for EPHS were selected from 63 PHIs in eight counties of Shandong province, China, using multi-stage stratified sampling. Of those, 2166 patients (response rate: 85.4%) completed face-to-face structured questionnaires on their utilization of community-based diabetes management care services. Further, 63 PHIs were surveyed on diabetes care delivery, and 444 primary healthcare providers were purposively sampled from those PHIs to measure their knowledge of diabetes management care delivery, using a self-developed questionnaire. Descriptive statistics were used to analyze the delivery and utilization of diabetes management care services. Multilevel logistic regression models were used to analyze the factors associated with patients’ utilization of diabetes management services. Results All 63 PHIs reported that all the required four diabetes management services were provided through EPHS. However, only 49.6% of the patients reported they fully used these services, with no statistically significant difference between urban and rural patients. Patients who had higher knowledge of diabetes and better self-efficacy in controlling the condition, were more likely to fully utilize diabetes management care. A larger number of PHI health staff per 1000 population was associated with better utilization of care. Conclusion Although community-based diabetes management services are well available to Chinese DM patients under the framework of EPHS, the actual utilization of diabetes management services among the patients was poor. The size of the PHI workforce, patients’ knowledge and self-efficacy in controlling diabetes, were important predictors of utilization, and could be enhanced to improve control of diabetes.
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Affiliation(s)
- Jingjing Yao
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - Haipeng Wang
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - Jia Yin
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - Di Shao
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - Xiaolei Guo
- Shandong Centers for Disease Control and Prevention, Jingshi Road, Lixia District, Jinan, 250012, China
| | - Qiang Sun
- School of Health Care Management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Wenhuaxi Road, Lixia District, Jinan, 250012, China.
| | - Xiao Yin
- Shandong University Affliated Jinan Center Hospital, Jiefang Road, Lixia District, Jinan, 250012, China.
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5
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Suppiah V, Lim CX, Hotham E. Community pharmacists and their role in pharmacogenomics testing: an Australian perspective drawing on international evidence. Aust J Prim Health 2018; 24:441-447. [PMID: 30409245 DOI: 10.1071/py18047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/19/2018] [Indexed: 12/11/2022]
Abstract
Patients obtaining a prescription from a pharmacy expect that the drug will be effective and have minimal side-effects. Unfortunately, drugs exhibit the desired effect in ~25-60% of people prescribed any medication. Adverse effects occur at a rate of 10% in patients taking a medication, and this rate increases during and after hospitalisation, with the transition of care back to the ambulatory setting posing a particular risk. Pharmacogenomics testing has been shown to optimise pharmacotherapy by increasing medication effectiveness and reducing drug-related toxicity, thus curtailing overall healthcare costs. Evidence from international studies have shown that community pharmacists would be able to offer this highly relevant professional service to their clients, given suitable training. This specific training complements pharmacists' existing skills and expertise by educating them in an emerging scientific area of pharmacogenomics. However, in an increasingly tight financial climate, the provision of pharmacogenomics testing by Australian community pharmacists will only be viable with an appropriate reimbursement through the Medicare Benefits Schedule, currently accessible by other allied health practitioners but not by pharmacists.
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Affiliation(s)
- Vijayaprakash Suppiah
- School of Pharmacy and Medical Sciences, University of South Australia, City West Campus, Adelaide, SA 5000, Australia
| | - Chiao Xin Lim
- School of Pharmacy and Medical Sciences, University of South Australia, City West Campus, Adelaide, SA 5000, Australia
| | - Elizabeth Hotham
- School of Pharmacy and Medical Sciences, University of South Australia, City West Campus, Adelaide, SA 5000, Australia
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6
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Investigating influences on current community pharmacy practice at micro, meso, and macro levels. Res Social Adm Pharm 2017; 13:727-737. [DOI: 10.1016/j.sapharm.2016.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/23/2022]
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7
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Bajorek B, Krass I. Exploring the potential for pharmacist prescribing in the management of hypertension in primary care: an Australian survey. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Beata Bajorek
- Graduate School of Health - Discipline of Pharmacy; University of Technology Sydney; Broadway Australia
| | - Ines Krass
- Faculty of Pharmacy; University of Sydney; Sydney Australia
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8
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Bajorek BV, LeMay KS, Magin PJ, Roberts C, Krass I, Armour CL. Management of hypertension in an Australian community pharmacy setting – patients’ beliefs and perspectives. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:263-273. [DOI: 10.1111/ijpp.12301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/14/2016] [Indexed: 12/01/2022]
Abstract
Abstract
Objective
To explore patients' perspectives and experiences following a trial of a pharmacist-led service in hypertension management.
Methods
A qualitative study comprising individual interviews was conducted. Patients of a community pharmacy, where a pharmacist-led hypertension management service had been trialled in selected metropolitan regions in Sydney (Australia), were recruited to the study. Emergent themes describing patients' experiences and perspectives on the service were elicited via thematic analysis (using manual inductive coding).
Key findings
Patients' (N = 18) experiences of the service were extremely positive, especially around pharmacists' monitoring of blood pressure and provision of advice about medication adherence. Patients' participation in the service was based on their trust in, and relationship with, their pharmacist. The perception of working in a ‘team' was conveyed through the pharmacist's caring style of communication and the relaxed atmosphere of the community pharmacy. Patients felt that the community pharmacy was an obvious place for such a service because of their regular contact with the pharmacist, but was limited because the pharmacists were not able to prescribe medication.
Conclusion
Patients were extremely positive about the role of, and their experience of, the pharmacy-based hypertension management service. Factors contributing to the patients' positive experiences provide important insights for community pharmacy practice. Good rapport with the pharmacist and a long-term relationship underpin patient engagement in such services. Restrictions on the pharmacists' scope of practice prevent their expertise, and the benefits of their accessibility as a primary point of contact, from being fully realised.
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Affiliation(s)
- Beata V Bajorek
- Graduate School of Health – Pharmacy, CB07.04.51, The University of Technology Sydney, Broadway, NSW, Australia
| | - Kate S LeMay
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia
| | - Parker J Magin
- Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia
| | - Christopher Roberts
- Sydney Medical School – Northern, Hornsby Ku-ring-Gai Hospital, Hornsby, NSW, Australia
| | - Ines Krass
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Carol L Armour
- Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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9
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Wong CY, Martinez J, Dass CR. Oral delivery of insulin for treatment of diabetes: status quo, challenges and opportunities. J Pharm Pharmacol 2016; 68:1093-108. [DOI: 10.1111/jphp.12607] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 06/10/2016] [Indexed: 12/12/2022]
Abstract
Abstract
Objectives
Diabetes mellitus is characterised by progressive β-cell destruction and loss of function, or loss of ability of tissues to respond to insulin. Daily subcutaneous insulin injection is standard management for people with diabetes, although patient compliance is hard to achieve due to the inconvenience of injections, so other forms of delivery are being tested, including oral administration. This review summarises the developments in oral insulin administration.
Methods
The PubMed database was consulted to compile this review comparing conventional subcutaneous injection of insulin to the desired oral delivery.
Key findings
Oral administration of insulin has potential benefits in reducing pain and chances of skin infection, improving the portal levels of insulin and avoiding side effects such as hyperinsulinemia, weight gain and hypoglycaemia. Although oral delivery of insulin is an ideal administration route for patients with diabetes, several physiological barriers have to be overcome. An expected low oral bioavailability can be attributed to its high molecular weight, susceptibility to enzymatic proteolysis and low diffusion rate across the mucin barrier.
Conclusions
Strategies for increasing the bioavailability of oral insulin include the use of enzyme inhibitors, absorption enhancers, mucoadhesive polymers and chemical modification for endogenous receptor-mediated absorption. These may help significantly increase patient compliance and disease management.
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Affiliation(s)
- Chun Y Wong
- School of Pharmacy, Curtin University, Bentley, Australia
| | - Jorge Martinez
- School of Pharmacy, Curtin University, Bentley, Australia
| | - Crispin R Dass
- School of Pharmacy, Curtin University, Bentley, Australia
- Curtin Biosciences Research Precinct, Bentley, Australia
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10
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Bajorek B, Lemay KS, Magin P, Roberts C, Krass I, Armour CL. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges. Pharm Pract (Granada) 2016; 14:723. [PMID: 27382427 PMCID: PMC4930861 DOI: 10.18549/pharmpract.2016.02.723] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/01/2016] [Indexed: 11/29/2022] Open
Abstract
Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control – usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.
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Affiliation(s)
- Beata Bajorek
- Academic Pharmacist and Associate Professor. Graduate School of Health - Pharmacy, University of Technology Sydney . Broadway, NSW ( Australia ).
| | - Kate S Lemay
- Woolcock Institute of Medical Research, University of Sydney . Glebe, NSW ( Australia ).
| | - Parker Magin
- Academic General Practitioner and Conjoint Professor, Discipline of General Practice, University of Newcastle . Callaghan, NSW ( Australia ).
| | - Christopher Roberts
- Associate Professor in Primary Care and Medical Education. Sydney Medical School - Northern, Hornsby Ku-ring-Gai Hospital. Hornsby, NSW ( Australia ).
| | - Ines Krass
- Professor of Pharmacy Practice. Faculty of Pharmacy, University of Sydney . Sydney, NSW ( Australia ).
| | - Carol L Armour
- Professor of Pharmacology and Executive Director Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Woolcock Institute of Medical Research, University of Sydney . Glebe, NSW ( Australia ).
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11
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Ayadurai S, Hattingh HL, Tee LBG, Md Said SN. A Narrative Review of Diabetes Intervention Studies to Explore Diabetes Care Opportunities for Pharmacists. J Diabetes Res 2016; 2016:5897452. [PMID: 27247949 PMCID: PMC4877480 DOI: 10.1155/2016/5897452] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/14/2016] [Indexed: 01/19/2023] Open
Abstract
Background. We conducted a review of current diabetes intervention studies in type 2 diabetes and identified opportunities for pharmacists to deliver quality diabetes care. Methods. A search on randomised controlled trials (RCT) on diabetes management by healthcare professionals including pharmacists published between 2010 and 2015 was conducted. Results and Discussion. Diabetes management includes multifactorial intervention which includes seven factors as outlined in diabetes guidelines, namely, glycaemic, cholesterol and blood pressure control, medication, lifestyle, education, and cardiovascular risk factors. Most studies do not provide evidence that the intervention methods used included all seven factors with exception of three RCT which indicated HbA1c (glycated hemoglobin) reduction range of 0.5% to 1.8%. The varied HbA1C reduction suggests a lack of standardised and consistent approach to diabetes care. Furthermore, the duration of most studies was from one month to two years; therefore long term outcomes could not be established. Conclusion. Although pharmacists' contribution towards improving clinical outcomes of diabetes patients was well documented, the methods used to deliver structured, consistent evidence-based care were not clearly stipulated. Therefore, approaches to achieving long term continuity of care are uncertain. An intervention strategy that encompass all seven evidence-based factors will be useful.
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Affiliation(s)
- Shamala Ayadurai
- Curtin University, School of Pharmacy, Kent Road, Bentley, Perth, WA 6102, Australia
| | - H. Laetitia Hattingh
- Curtin University, School of Pharmacy, Kent Road, Bentley, Perth, WA 6102, Australia
| | - Lisa B. G. Tee
- Curtin University, School of Pharmacy, Kent Road, Bentley, Perth, WA 6102, Australia
| | - Siti Norlina Md Said
- Ministry of Health, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor, Malaysia
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12
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Paul CL, Piterman L, Shaw JE, Kirby C, Barker D, Robinson J, Forshaw KL, Sikaris KA, Bisquera A, Sanson-Fisher RW. Patterns of type 2 diabetes monitoring in rural towns: How does frequency of HbA1c and lipid testing compare with existing guidelines? Aust J Rural Health 2016; 24:371-377. [PMID: 27086673 DOI: 10.1111/ajr.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To indicate levels of monitoring of type 2 diabetes in rural and regional Australia by examining patterns of glycated haemoglobin (HbA1c) and blood lipid testing. DESIGN AND SETTING Retrospective analysis of pathology services data from twenty regional and rural towns in eastern Australia over 24 months. PARTICIPANTS Of 13 105 individuals who had either a single HbA1c result ≥7.0% (53 mmol mol-1 ); or two or more HbA1c tests within the study period. MAIN OUTCOME MEASURES Frequency of testing of HbA1c and blood lipids (cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides) were compared with guideline recommendations. RESULTS About 58.3% of patients did not have the recommended 6-monthly HbA1c tests and 30.6% did not have annual lipid testing. For those who did not receive tests at the recommended interval, the mean between-test interval was 10.5 months (95% CI = 7.5-13.5) rather than 6 months for HbA1c testing; and 15.7 (95% CI = 13.3-18.1) months rather than annually for blood lipids. For those with at least one out-of-range test result, 77% of patients failed to receive a follow-up HbA1c test and 86.5% failed to receive a follow-up blood lipid test within the recommended 3 months. Patients less than 50 years of age, living in a more remote area and with poor diabetes control were less likely to have testing at the recommended intervals (P < 0.0001). CONCLUSIONS Although poor diabetes testing is not limited to rural areas, more intensive diabetes monitoring is likely to be needed for patients living in non-metropolitan areas, particularly for some subgroups.
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Affiliation(s)
- Christine L Paul
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, Callaghan, Australia
| | - Leon Piterman
- Department of General Practice, Berwick and Peninsula Campuses, Monash University, Berwick, Australia
| | - Jonathan E Shaw
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Melbourne, Australia.,Clinical Diabetes and Epidemiology Group, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Catherine Kirby
- Department of General Practice, Berwick and Peninsula Campuses, Monash University, Berwick, Australia
| | - Daniel Barker
- School of Medicine and Public Health, Callaghan, Australia.,Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, Australia
| | | | - Kristy L Forshaw
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, Callaghan, Australia
| | - Kenneth A Sikaris
- Melbourne Pathology, Sonic Healthcare, Melbourne, Victoria, Australia
| | - Alessandra Bisquera
- Hunter Medical Research Institute, CReDITSS, New Lambton Heights, New South Wales, Australia
| | - Robert W Sanson-Fisher
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, Callaghan, Australia
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13
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Lemay KS, Saini B, Bosnic-Anticevich S, Smith L, Stewart K, Emmerton L, Burton DL, Krass I, Armour CL. An exploration of clinical interventions provided by pharmacists within a complex asthma service. Pharm Pract (Granada) 2015; 13:529. [PMID: 25883692 PMCID: PMC4384270 DOI: 10.18549/pharmpract.2015.01.529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 02/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pharmacists in Australia are accessible health care professionals, and their provision of clinical pharmacy interventions in a range of areas has been proven to improve patient outcomes. Individual clinical pharmacy interventions in the area of asthma management have been very successful. An understanding of the nature of these interventions will inform future pharmacy services. What we do not know is when pharmacists provide a complex asthma service, what elements of that service (interventions) they choose to deliver. OBJECTIVE To explore the scope and frequency of asthma-related clinical interventions provided by pharmacists to patients in an evidence-based complex asthma service. METHODS Pharmacists from 4 states/territories of Australia were trained in asthma management. People with asthma had 3 or 4 visits to the pharmacy. Guided by a structured patient file, the pharmacist assessed the patient's asthma and management and provided interventions where and when considered appropriate, based on their clinical decision making skills. The interventions were recorded in a checklist in the patient file. They were then analysed descriptively and thematically. RESULTS Pharmacists provided 22,909 clinical pharmacy interventions over the service to 570 patients (398 of whom completed the service). The most frequently delivered interventions were in the themes 'Education on asthma', 'Addressing trigger factors', 'Medications - safe and effective use' and 'Explore patient perspectives'. The patients had a high and ongoing need for interventions. Pharmacists selected interventions based on their assessment of perceived need then revisited and reinforced these interventions. CONCLUSION Pharmacists identified a number of areas in which patients required interventions to assist with their asthma management. Many of these were perceived to require continuing reinforcement over the duration of the service. Pharmacists were able to use their clinical judgement to assess patients and provide clinical pharmacy interventions across a range of asthma management needs.
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Affiliation(s)
- Kate S Lemay
- Woolcock Institute of Medical Research, The University of Sydney . Sydney, NSW ( Australia ).
| | - Bandana Saini
- Faculty of Pharmacy, The University of Sydney . Sydney, NSW ( Australia ).
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, The University of Sydney ; and Sydney Local Health District. Sydney, NSW ( Australia ).
| | - Lorraine Smith
- Faculty of Pharmacy, The University of Sydney . Sydney, NSW ( Australia ).
| | - Kay Stewart
- Centre for Medicine Use and Safety, Monash University , VIC ( Australia ).
| | - Lynne Emmerton
- School of Pharmacy, Faculty of Health Sciences, Curtin University , Perth, WA ( Australia ).
| | | | - Ines Krass
- Faculty of Pharmacy, The University of Sydney . Sydney, NSW ( Australia ).
| | - Carol L Armour
- Woolcock Institute of Medical Research, The University of Sydney ; and Sydney Local Health District, Sydney, NSW ( Australia ).
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Thepwongsa I, Kirby C, Schattner P, Shaw J, Piterman L. Type 2 diabetes continuing medical education for general practitioners: what works? A systematic review. Diabet Med 2014; 31:1488-97. [PMID: 25047877 DOI: 10.1111/dme.12552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/24/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
AIMS To perform a systematic review of studies that have assessed the effectiveness of interventions designed to improve healthcare professionals' care of patients with diabetes and to assess the effects of educational interventions targeted at general practitioners' diabetes management. METHODS A computer search was conducted using the Cochrane Library, PubMed, Ovid MEDLINE, Scopus, EMBASE, Informit, Google scholar and ERIC from the earliest date of each database up until 2013. A supplementary review of reference lists from each article obtained was also carried out. Measured changes in general practitioners' satisfaction, knowledge, practice behaviours and patient outcomes were recorded. RESULTS Thirteen out of 1255 studies met the eligibility criteria, but none was specifically conducted in rural or remote areas. Ten studies were randomized trials. Fewer than half of the studies (5/13, 38.5%) reported a significant improvement in at least one of the following outcome categories: satisfaction with the programme, knowledge and practice behaviour. There was little evidence of the impact of general practitioner educational interventions on patient outcomes. Of the five studies that examined patient outcomes, only one reported a positive impact: a reduction in patient HbA1c levels. CONCLUSIONS Few studies examined the effectiveness of general practitioner Type 2 diabetes education in improving general practitioner satisfaction, knowledge, practices and/or patient outcomes. Evidence to support the effectiveness of education is partial and weak. To determine effective strategies for general practitioner education related to Type 2 diabetes, further well designed studies, accompanied by valid and reliable evaluation methods, are needed.
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Affiliation(s)
- I Thepwongsa
- Department of General Practice, School of Primary Health Care, Monash University, Notting Hill
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15
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Clifford S, Perez-Nieves M, Skalicky AM, Reaney M, Coyne KS. A systematic literature review of methodologies used to assess medication adherence in patients with diabetes. Curr Med Res Opin 2014; 30:1071-85. [PMID: 24432796 DOI: 10.1185/03007995.2014.884491] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Adhering to prescribed medication is often a problem for patients with diabetes yet there is no consensus on how best to measure adherence in this patient population. This systematic literature review critically reviewed and summarized the methods used to measure medication adherence in patients with diabetes (on oral hypoglycemic agents [OHAs] and/or insulin) in original research published between 2007-2013. STUDY DESIGN Literature review. METHODS A systematic search for methods to assess medication adherence in patients with type I or type II diabetes was conducted using PubMed, EMBASE, PsychInfo, and Cochrane databases. Two researchers independently screened abstracts for initial eligibility and then applied the inclusion/exclusion criteria to the relevant full-text articles. RESULTS Fifty-nine articles met the criteria for inclusion. Subjective assessment (observer-reported and patient-reported), pill counts, Medication Event Monitoring System (MEMS), cell-phone real-time assessment, and logbooks were used in prospective studies. In pharmacy claims databases, medication possession ratios (MPRs), or some derivation thereof, were utilized. Each method has strengths and weaknesses, but few approaches specifically addressed issues unique to assessing insulin adherence. Three novel approaches (using cell-phone real-time assessment, computerized logbooks, and a questionnaire about different dosing irregularities) provided insight on timing and dosing issues that could be useful for highlighting interventions to improve insulin adherence. CONCLUSION No gold standard exists for measuring medication adherence in patients with diabetes. The plethora of adherence methods precludes the comparison of adherence rates across studies. Greater consistency is therefore needed in adherence measurement, including question content, recall period, and response options for self-report measures. Novel methods for understanding adherence to variable-dosed insulin require further research. Researchers should select a methodology that best fits their research question, study design, patient population and resources.
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Chung WW, Chua SS, Lai PSM, Chan SP. Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes. Patient Prefer Adherence 2014; 8:1185-94. [PMID: 25214772 PMCID: PMC4159395 DOI: 10.2147/ppa.s66619] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a lifelong chronic condition that requires self-management. Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes. PURPOSE To assess the effects of a pharmaceutical care (PC) model on medication adherence and glycemic levels of people with type 2 diabetes mellitus. PATIENTS AND METHODS A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at random to the control (n=121) or intervention (n=120) groups. Participants in the intervention group received PC from an experienced pharmacist, whereas those in the control group were provided the standard pharmacy service. Medication adherence was assessed using the Malaysian Medication Adherence Scale, and glycemic levels (glycated hemoglobin values and fasting blood glucose [FBG]) of participants were obtained at baseline and after 4, 8, and 12 months. RESULTS At baseline, there were no significant differences in demographic data, medication adherence, and glycemic levels between participants in the control and intervention groups. However, statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4, 8, and 12 after the provision of PC (median FBG, 9.0 versus 7.2 mmol/L [P<0.001]; median glycated hemoglobin level, 9.1% versus 8.0% [P<0.001] at 12 months). Medication adherence was also significantly associated with the provision of PC, with a higher proportion in the intervention group than in the control group achieving it (75.0% versus 58.7%; P=0.007). CONCLUSION The provision of PC has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes. Therefore, the PC model used in this study should be duplicated in other health care settings for the benefit of more patients with type 2 diabetes.
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Affiliation(s)
- Wen Wei Chung
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Siew Siang Chua
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, University Malaya Primary Care Research Group, Kuala Lumpur, Malaysia
| | - Siew Pheng Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Correspondence: Siew Siang Chua, Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia, Tel +60 3 7967 6688, Fax +60 3 7967 4964, Email
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Ladhani NN, Majumdar SR, Johnson JA, Tsuyuki RT, Lewanczuk RZ, Spooner R, Simpson SH. Adding pharmacists to primary care teams reduces predicted long-term risk of cardiovascular events in type 2 diabetic patients without established cardiovascular disease: results from a randomized trial. Diabet Med 2012; 29:1433-9. [PMID: 22486226 DOI: 10.1111/j.1464-5491.2012.03673.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine the impact of adding pharmacists to primary care teams on predicted 10-year risk of cardiovascular events in patients with Type 2 diabetes without established cardiovascular disease. METHODS This was a pre-specified secondary analysis of randomized trial data. The main study found that, compared with usual care, addition of a pharmacist resulted in improvements in blood pressure, dyslipidaemia, and hyperglycaemia for primary care patients with Type 2 diabetes. In this sub-study, predicted 10-year risk of cardiovascular events at baseline and 1 year were calculated for patients free of cardiovascular disease at enrolment. The primary outcome was change in UK Prospective Diabetes Study (UKPDS) risk score; change in Framingham risk score was a secondary outcome. RESULTS Baseline characteristics were similar between the 102 intervention patients and 93 control subjects: 59% women, median (interquartile range) age 57 (50-64) years, diabetes duration 3 (1-6.5) years, systolic blood pressure 128 (120-140) mmHg, total cholesterol 4.34 (3.75-5.04) mmol/l and HbA(1c) 54 mmol/mol (48-64 mmol/mol) [7.1% (6.5-8.0%)]. Median baseline UKPDS risk score was 10.2% (6.0-16.7%) for intervention patients and 9.5% (5.8-15.1%) for control subjects (P = 0.80). One-year post-randomization, the median absolute reduction in UKPDS risk score was 1.0% greater for intervention patients compared with control subjects (P = 0.032). Similar changes were seen with the Framingham risk score (median reduction 1.2% greater for intervention patients compared with control subjects, P = 0.048). The two risk scores were highly correlated (rho = 0.83; P < 0.001). CONCLUSION Adding pharmacists to primary care teams for 1 year significantly reduced the predicted 10-year risk of cardiovascular events for patients with Type 2 diabetes without established cardiovascular disease.
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Affiliation(s)
- N N Ladhani
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
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Jiwa M, Meng X, Sriram D, Hughes J, Colagiuri S, Twigg SM, Skinner T, Shaw T. The management of Type 2 diabetes: a survey of Australian general practitioners. Diabetes Res Clin Pract 2012; 95:326-32. [PMID: 22153417 DOI: 10.1016/j.diabres.2011.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 10/31/2011] [Accepted: 11/07/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore how clinical and demographic variables impact on the management of diabetes mellitus in general practice. DESIGN A structured vignette survey was conducted in Australia. This included nine vignettes chosen at random from 128 developed around seven clinical variables. Respondents were asked to recommend a change in treatment and make specific recommendations. A random sample of general practitioners (GPs) were recruited. Two diabetologists involved in the development of national guidelines also participated. RESULTS 125 (13.8%) GPs participated. Statistical analyses were used to generate outcome measures. GPs recommended a change in treatment for most (81.1%) cases; were less likely to prescribe a statin (68.5% GPs vs. 76.3% diabetologists), less likely to treat hypertension (66.7% vs.89%) and less likely to refer for lifestyle modification (82.3% vs. 96.5%). Significant disagreement occurred around prescribing or changing oral hypoglycaemics. No GP characteristics showed significant impact. The proportion of GPs who agreed with diabetiologists on dose and choice of drugs was 35.7% for statins, 49.6% for antihypertensives and 39.6% for oral hypoglycaemics. CONCLUSIONS There were significant differences between diabetologists and GPs on the management of diabetes. The survey suggests significant under-dosing by GPs. These findings warrant further investigation.
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Affiliation(s)
- M Jiwa
- Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.
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