Professional development of pharmaceutical care in type 2 diabetes mellitus: a multidisciplinary conceptual model

An evaluation of community pharmacy-based services for type 2 diabetes in an Indonesian setting: patient survey

Background. Diabetes is an emerging chronic disease in developing countries. Its management in developing countries is mainly hospital/clinic based. The increasing diabetes burden in developing countries provides opportunities for community pharmacists to deliver a range of services. Since the management of diabetes requires the patient’s own involvement, it is important to gain their views in order to develop pharmacy-based diabetes services. Studies on diabetes patients’ views have been limited to developed countries.

Objectives. To investigate, within a developing country setting (Indonesia), current use of pharmacy services by type 2 diabetes patients, and to evaluate their views regarding community pharmacists’ roles, and the characteristics that influence their views.

Methods. A questionnaire survey was conducted within 10 purposefully selected community pharmacies in Surabaya, Indonesia. Each pharmacy recruited approximately 20 patients seeking antidiabetic medications. Usage of pharmacy services was identified using binary responses (‘yes’/‘no’) and views on pharmacists’ roles were rated using Likert scales; an open-ended question was used to identify patient perceived priority roles. Logistic regression models were used to determine characteristics associated with patients’ views.

Results. A total of 196 pharmacy patients with type 2 diabetes responded (58.3% response rate). Most patients used community pharmacies for dispensing (100%) and education on how to use medications (79.6%). There were mixed views towards pharmacists providing services beyond dispensing. The highest priorities identified were from the ‘patient education’ domain: education on medications (i.e., directions for use (64.5%), storage (26.6%), common/important adverse effects (25.5%)); and the ‘monitoring’ domain: monitoring medication compliance (37.3%). Patients with higher incomes or who were working were less supportive of these expanded services, whereas patients who previously used a service, those with risk factors for complications or having poor/unknown glycaemic control were more supportive.

Conclusions. Community pharmacies in Surabaya, Indonesia in this study were mainly utilised for dispensing. However, many type 2 diabetes patients using these pharmacies report limited monitoring of blood glucose levels and poor glycaemic control, which indicates an opportunity for greater pharmacist involvement. Yet for this to occur, patients’ limited expectations of pharmacists roles will need to be broadened. Characteristics influencing these views should inform the development of pharmacy-based diabetes services in the environment of the burgeoning burden of diabetes.

Exploring the patient perspective regarding community pharmacists' educational roles in diabetes medication and blood glucose management

Objective

Applying role theory, we studied patients' beliefs about community pharmacists' roles and corresponding unaddressed educational needs in the area of diabetes medication and blood glucose management.

Setting

United States, nationwide sample.

Method

Persons with diabetes were surveyed by mail. Inclusion criteria required individuals to be non-institutionalised adults (≥18 years old) with type 1 or type 2 diabetes and taking at least one prescription diabetes medication.

Key findings

The most-frequent role beliefs for pharmacists included teaching patients about how to reduce the cost of their medications and about side-effects and symptom management. The most common unaddressed need reported by patients was reducing their drug costs, and those who reported at least one unaddressed need were more likely to be younger, female and black. Ten per cent of patients believed that only a pharmacist is able to educate them about medication and blood glucose management. Compared with the remainder of the study sample, these patients were on average more-highly educated, more-recently diagnosed, and visited their pharmacy more often in the last 30 days seeking advice from a pharmacist and non-prescription medications. Notably, they also reported fewer unaddressed needs overall.

Conclusion

Knowing the beliefs of a person with diabetes regarding who is capable of educating them about medication and blood glucose management, and knowing their related unaddressed educational needs is useful to community pharmacists who serve these patients as well as to pharmacy management as the profession continues to move forward to provide advanced care to patients with diabetes.

A consensus model for delivery of structured pharmaceutical care for the patient with type 2 diabetes mellitus by Scottish community pharmacists

Objective

To generate a model of pharmaceutical care for the patient with type 2 diabetes mellitus in primary care, from a consensus determined among community pharmacists in Scotland. Setting Community pharmacists within Scotland already involved in providing structured pharmaceutical care.

Method

The Delphi questionnaire was based on a validated multidisciplinary model of care for the patient with type 2 diabetes mellitus in primary care comprising 47 items under five themes: assessment, treatment plan, treatment administration, patient monitoring, confirmation/review. Seventy participants already participating in a pharmaceutical care model schemes initiative to encourage pharmaceutical care from community pharmacies and with an interest in diabetes mellitus were sent an initial questionnaire. Thirty-seven participants agreed to enter two further rounds; response rates were 22/37 (59%) and 18/22 (82%). Final round cut-off defining consensus was 80% scoring 6–7 from a seven-point Likert scale.

Key findings

A model emerged from the achieved consensus. There was an early consensus achieved on the core functions that participants were already delivering to the patient with diabetes mellitus. These are functions that have been highlighted and delivered in previous studies within this disease state: receiving and sharing patient information, individualising treatment, identifying unsatisfactory treatment and monitoring and prescribing analgesia.

Conclusions

For service development and linked continued professional development a well-defined service model for delivering pharmaceutical care to patients is required. This study proposes such a model based on consensus among a self-selected group of community pharmacists leading diabetes pharmacy practice in Scotland.