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Zhang L, Lin H, Wu W, Zhuang J, Huang L, Wang Y, Liu J, Hu C, Wei X. A meta-analysis of the impact of pharmacist interventions on clinical outcomes in patients with type-2 diabetes. PATIENT EDUCATION AND COUNSELING 2024; 120:108091. [PMID: 38071931 DOI: 10.1016/j.pec.2023.108091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/12/2023] [Accepted: 11/25/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVE To evaluate the effects of pharmacist interventions in type-2 diabetes patients by collecting and evaluating literature. METHODS A systematic search was conducted across six databases, including CNKI, Wanfang Data, VIP, PubMed, Web of Science, and Cochrane Library, from January 2001 to January 2023. Randomized controlled trials evaluating the clinical outcomes of pharmacist interventions on type-2 diabetes patients were searched, and data were extracted and analysed by RevMan version 5.4 software. RESULTS A total of 35 studies involving 4827 patients were included. Meta-analysis demonstrated that pharmacist interventions had an influence on improving patients' HbA1c (MD=-0.70), LDL-C (MD=-5.51), SBP (MD=-4.58), DBP (MD=-1.90], BMI (MD=-0.47) and FBG (MD=-19.82), but there was no evidence from the study that pharmacist interventions could significantly improve HDL-C (MD=-0.61), TC (MD=-5.12) or TG (MD=-3.14). In addition, medication adherence was significantly improved. CONCLUSION Pharmacist interventions significantly improved HbA1c, BP, and LDL-C control levels, BMI, and medication adherence in type-2 diabetes patients, but there was no evidence from this study that pharmacist interventions significantly improved HDL-C, TC, or TG. PRACTICE IMPLICATIONS Effective pharmacist interventions are important to improve type-2 diabetes patients' clinical outcomes.
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Affiliation(s)
- LiRong Zhang
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, China; School of Pharmacy, Fujian Medical University, China
| | - Huiting Lin
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, China; School of Pharmacy, Fujian Medical University, China
| | - Wenhua Wu
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, China; School of Pharmacy, Fujian Medical University, China
| | - Jie Zhuang
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, China
| | - Longpeng Huang
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, China; School of Pharmacy, Fujian University of Traditional Chinese Medicine, China
| | - Yiming Wang
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, China; School of Pharmacy, Fujian University of Traditional Chinese Medicine, China
| | - Jia Liu
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, China; School of Pharmacy, Fujian Medical University, China
| | - Congting Hu
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, China; School of Pharmacy, Fujian Medical University, China
| | - XiaoXia Wei
- Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, China; School of Pharmacy, Fujian Medical University, China.
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Sun Q, Wan C, Xu Z, Huang Y, Xi X. Association of pharmaceutical care barriers and role ambiguity and role conflict of clinical pharmacists. Front Pharmacol 2023; 14:1103255. [PMID: 37229262 PMCID: PMC10203618 DOI: 10.3389/fphar.2023.1103255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Objectives: This study aimed to understand current status of pharmaceutical care barriers and explore the impact of them on the role ambiguity and role conflict of clinical pharmacists in secondary and tertiary hospitals in mainland China. Methods: The Chinese version of Role Conflict and Role Ambiguity Scale was used to measure clinical pharmacists' role ambiguity and role conflict. A questionnaire for clinical pharmacists' pharmaceutical care barriers was established to determine whether clinical pharmacists encounter barriers. Multiple linear regression model was used to analyze the influence of various pharmaceutical care barriers on the role ambiguity and role conflict of clinical pharmacists. Results: 1,300 clinical pharmacists from 31 provinces were eventually included. The results revealed that commonly perceived barriers to pharmaceutical care by clinical pharmacists include the lack of financial compensation and dedicated time for pharmaceutical care. Barriers such as clinical pharmacists' unawareness of the importance of pharmaceutical care increase the degree of clinical pharmacists' role conflict. And the lack of financial compensation for pharmaceutical care decreases the degree of role ambiguity, while barriers such as the lack of dedicated time for pharmaceutical care, the failure to standardize the service procedures and contents of related documents in healthcare institutions increase the degree of role ambiguity. Conclusion: Increased focus on enhancing financial compensation, responsibility cognition, education and training, and greater consideration of institutional factors could help clinical pharmacists better manage their work environments and provide higher-quality pharmaceutical care.
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Hatem NAH, Mohamed Ibrahim MI, Halboup A, Kubas M. A Multi-Institutional Study of Yemeni Final Year Undergraduate Pharmacy Students' Understanding, Attitudes, and Perceived Barriers Toward Provision of Pharmaceutical Care: A Cross-Sectional Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:109-121. [PMID: 36816050 PMCID: PMC9930587 DOI: 10.2147/amep.s392886] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Pharmaceutical care (PC) is the philosophy of the pharmacist's practice to achieve a better health-related outcome by designing, implementing and monitoring the therapeutic plans. It is in its infancy in Yemen. Hence, the study objectives were to examine the barriers to PC provision as perceived by Yemen pharmacy students and to assess their level of understanding of PC and their attitudes toward PC. METHODOLOGY A cross-sectional study was conducted among ten pharmacy colleges in Yemen, offering undergraduate pharmacy programs. A stratified sample of 518 students from the included universities were surveyed using a well-structured, validated and self-administered questionnaire. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were conducted at an alpha level of 0.05. RESULTS Four hundred and seventy-five (475) participants were included (92.9% response rate). More than 17% (n=84) of participants were involved in Pharm.D program, and nearly 29.9% (n=142) preferred pharmaceutical marketing as a career after graduation. About 65% of participants recognized the purpose of PC, and pharmacists' role within PC. However, only 43.8% (n=208) knew the difference between clinical pharmacy and PC. About 82% of respondents showed very good attitudes toward PC. Pharm.D students showed higher attitudes' total scores, median (IQR): 4.3 (4.1-4.4), 4.2 (4-4.2) and 4 (3.9-4.2) for Pharm.D, bachelor of pharmacy and bachelor of clinical pharmacy respectively, (p-value = 0.032). Moreover, students who currently employed in pharmacy-related job during their study were also associated with high attitudes scores compared to unemployed students, median (IQR): 4.2 (4-4.4) and 4(3.9-4.1) respectively (p-value = 0.023). "Lack of access to the patient medical record in the pharmacy" and "inadequate (hospital and community pharmacy) internship period" were the top reported barriers with 81.5% (n=387) agreement. CONCLUSION Although PC is in its infancy in Yemen, pharmacy students showed positive attitudes toward practicing PC. Educational institutions should exert efforts for curricular revision to improve understanding, and overcome the reported barriers in the future.
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Affiliation(s)
- Najmaddin A H Hatem
- Department of Pharmacy Practice, College of Clinical Pharmacy, Hodeidah University, Alhodeidah, Yemen
| | | | - Abdulsalam Halboup
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana’a, Yemen
- Discipline of Clinical Pharmacy, University Sains Malaysia, Penang, Malaysia
| | - Mohammed Kubas
- Clinical Pharmacy Department, University of Science and Technology Hospital, Sana’a, Yemen
- Clinical Pharmacy Department, School of Pharmacy, Lebanese International University, Sana’a, Yemen
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Hassan F, Hatah E, Ali AM, Wen CW. The intervention strategies and service model for pharmacist-led diabetes management: a scoping review. BMC Health Serv Res 2023; 23:46. [PMID: 36653832 PMCID: PMC9847048 DOI: 10.1186/s12913-022-08977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is increasing intervention activities provided during pharmacist-led diabetes management. Nevertheless, there is an unclear definition of the activities involved during the intervention. Thus, this study aimed to describe the type of intervention strategies and service model provided during pharmacist-led type 2 diabetes management and service outcomes. METHODS This study utilized the scoping review methodology of the Joanna Briggs Institute Reviewers' Manual 2015. Articles on pharmacist-led diabetes management focusing on the service content, delivery methods, settings, frequency of appointments, collaborative work with other healthcare providers, and reported outcomes were searched and identified from four electronic databases: Ovid Medline, PubMed, Scopus, and Web of Science from 1990 to October 2020. Relevant medical subject headings and keywords, such as "diabetes," "medication adherence," "blood glucose," "HbA1c," and "pharmacist," were used to identify published articles. RESULTS The systematic search retrieved 4,370 articles, of which 61 articles met the inclusion criteria. The types of intervention strategies and delivery methods were identified from the studies based on the description of activities reported in the articles and were tabulated in a summary table. CONCLUSION There were variations in the descriptions of intervention strategies, which could be classified into diabetes education, medication review, drug consultation/counseling, clinical intervention, lifestyle adjustment, self-care, peer support, and behavioral intervention. In addition, most studies used a combination of two or more intervention strategy categories when providing services, with no specific pattern between the service model and patient outcomes.
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Affiliation(s)
- Fahmi Hassan
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia ,grid.415759.b0000 0001 0690 5255Pharmacy Services Program, Ministry of Health Malaysia, Lot 36 Jalan Universiti, 46350 Petaling Jaya, Selangor Malaysia
| | - Ernieda Hatah
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Chong Wei Wen
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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Wu M, Xu X, Zhao R, Bai X, Zhu B, Zhao Z. Effect of Pharmacist-Led Interventions on Medication Adherence and Glycemic Control in Type 2 Diabetic Patients: A Study from the Chinese Population. Patient Prefer Adherence 2023; 17:119-129. [PMID: 36660042 PMCID: PMC9843620 DOI: 10.2147/ppa.s394201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Medication adherence plays an important role in glycemic control in type 2 diabetes mellitus (T2DM) self-management. To analyze the factors influencing medication adherence in T2DM patients and the effect of pharmacist-led interventions, we conducted a study in Beijing, China. PATIENTS AND METHODS T2DM patients with hypoglycemic drugs for at least 6 months were enrolled. A pharmacist-led survey was conducted followed by individualized interventions for those non-adherent patients monthly within 3 months. FPG, HbA1c, and 2hPG were measured as the comprehensive glycemic control. Medication adherence was determined according to the patient's self-reported compliance with prescribed medication during the last 3 months. RESULTS A total of 763 T2DM patients were included. The average age was 63.26±11.89 years, with 363 males. After pharmacist intervention, the patients with good adherence increased from 34.21% to 39.06%, while poor adherence decreased from 32.5% to 24.5% (p < 0.001). The average adherence score was a significant increase (p < 0.001) from 27.846±4.185 to 29.831±7.065. Furthermore, our study demonstrated that pharmacist-led interventions significantly increased glycemic control (FPG from 42.33% to 53.60%, p < 0.001; 2hPG from 41.68% to 48.75%, p = 0.005; HbA1c from 24.12% to 29.23%, p = 0.024). The results found that body mass index (OR 0.643, 95% CI 0.437-0.945), use of medications empirically (occasionally (OR=3.066, 95% CI 2.069-4.543); often (OR=2.984, 95% CI 1.107-8.044)), following the doctor's advice to visit (OR 2.129, 95% CI 1.079-4.202) and lifestyle compliance (OR 2.835, 95% CI 1.094-7.346) were the independent risk factors of non-adherence (p < 0.05), the area under the ROC curve was 0.716. CONCLUSION Self-reported medication adherence and glycemic control in T2DM patients were poor which can be improved by pharmacist-led interventions. Interventions should focus on empirical medication behavior, non-adherence to lifestyle, and failure to follow the doctor's advice. The recall bias with self-reported results needs further objective data to verify.
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Affiliation(s)
- Mingfen Wu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
| | - Xiaohan Xu
- Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Xiangrong Bai
- Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, 100053, People’s Republic of China
| | - Bin Zhu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China
- Correspondence: Zhigang Zhao; Bin Zhu, Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +8601059978036; +8601059975444, Fax +8601059976856, Email ;
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Xiao J, Wang Q, Tan S, Chen L, Tang B, Huang S, Zhou Y, Xu P. Analysis of patient medication compliance and quality of life of physician-pharmacist collaborative clinics for T2DM management in primary healthcare in China: A mixed-methods study. Front Pharmacol 2023; 14:1098207. [PMID: 37033638 PMCID: PMC10080104 DOI: 10.3389/fphar.2023.1098207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Abstract
Background: Physician-pharmacist collaboration is a well-established care mode for the management of type 2 diabetes mellitus (T2DM) in developed countries, but no study has been conducted in primary healthcare in China. This study aims to evaluate the effects of physician-pharmacist collaborative clinics to manage T2DM in primary healthcare in China, and to better understand the factors influencing the implementation of physician-pharmacist collaborative clinics. Methods: Two hundred and sixty-seven patients involved in a 12-month randomized controlled trial were assigned to physician-pharmacist collaborative clinics and usual clinics, completing surveys regarding medication compliance, quality of life (QoL) and care-seeking behavior at the baseline, 3rd, 6th, 9th and 12th month respectively, and diabetes knowledge at baseline and 12th month. A sample of twenty-two Patients, nine physicians and twelve pharmacists participated in semi-structured face-to-face interviews. The quantitative and qualitative data was integrated by triangulation. Results: Patients in physician-pharmacist collaborative clinics had significant improvements in medication compliance (p = 0.009), QoL (p = 0.036) and emergency visits (p = 0.003) over the 12-month. Pairwise comparison showed the medication compliance score in the intervention group had been significantly improved at 3rd month (p = 0.001), which is more rapidly than that in the control group at 9th month (p = 0.030). Factors influencing the implementation of physician-pharmacist collaborative clinics were driven by five themes: pharmaceutical service, team-base care, psychological support, acceptability of care and barriers to implementation. Conclusion: Integration of quantitative and qualitative findings showed the effectiveness of physician-pharmacist collaborative clinics in patient medication compliance and QoL in primary healthcare. The qualitative study uncovered barriers in insufficient clinical experience and understaffing of pharmacist. Therefore, the professional training of the primary pharmacist team should be improved in the future. Clinical Trial Registration: clinicaltrials.gov, identifier ChiCTR2000031839.
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Affiliation(s)
- Jie Xiao
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qing Wang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shenglan Tan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Chen
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bingjie Tang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuting Huang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yangang Zhou
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Ping Xu,
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Alsayed AR. Illustrating How to Use the Validated Alsayed_v1 Tools to Improve Medical Care: A Particular Reference to the Global Initiative for Asthma 2022 Recommendations. Patient Prefer Adherence 2023; 17:1161-1179. [PMID: 37143905 PMCID: PMC10153448 DOI: 10.2147/ppa.s403239] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/07/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose The current research aimed to illustrate a real case using the validated Alsayed_v1 tools as tutorial training to improve the knowledge and skills of healthcare practitioners in the clinical problem-solving process necessary to implement medical and pharmaceutical care. Patients and Methods The Alsayed_v1 instruments consist of principal components: data collection, assessment of treatments, the medical problem oriented plan (MPOP), as well as a care plan and patient education. Results This study illustrated a real case of asthma patient using the validated Alsayed_v1 tools. These validated and clinically tested tools provide a coding system for the MPOP that permits easy documentation with an open hierarchical structure where higher levels are broad and lower levels are particular, and the possibility to enter free text. The section dedicated to treatment assessments is intended to synthesize patient information to facilitate the identification of the MPOPs. Effective management requires the development of a partnership between the patient with asthma (or the patient's caregivers) and his healthcare professional(s). This partnership aims to allow the patient to control his condition with guidance from the healthcare professional(s), discuss and agree on therapy goals, and develop a personalized, written, self-management asthma care plan. Conclusion By implementing Alsayed_v1 tools, the clinical practitioner can actively give the best practice for optimal patient outcomes.
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Affiliation(s)
- Ahmad R Alsayed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, 11937, Jordan
- Correspondence: Ahmad R Alsayed, (PharmD, MSc, PhD in Therapeutics and Precision Medicine), Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan, Tel +962786770778, Email ;
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Othman MM, Khudadad H, Dughmosh R, Furuya-Kanamori L, Abou-Samra AB, Doi SAR. Towards a better understanding of self-management interventions in type 2 diabetes: A concept analysis. Prim Care Diabetes 2022; 16:142-149. [PMID: 34556438 DOI: 10.1016/j.pcd.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Diabetes self-management educational (DSME) interventions can vary considerably, and it is unclear what is the operational conceptualization of the ideal delivery to individuals with type 2 diabetes (T2D). DESIGN From a search conducted concurrently we extracted and evaluated the 50 most recently published DSME intervention studies. Based on an analysis of these studies, we undertook a concept analysis using the Walker and Avant framework. RESULTS Five attributes describing the concept were recognized and organized into two groups. Group (a): skills related attributes that included (1) decision making, (2) problem solving and (3) taking action. Group (b): information related attributes that included (4) patient-provider interaction and (5) resource utilization. CONCLUSIONS The outcomes of this study make the operational conceptualization of the ideal DSME intervention measurable through its attributes and hence clarifies its delivery. This will improve the implementation of the key attributes in diabetes self-management intervention programs for T2D.
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Affiliation(s)
- Manal M Othman
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; Medicine Department, Hamad General Hospital, Doha, Qatar.
| | - Hanan Khudadad
- Department of Clinical Research, Primary Health Care Corporation, Doha, Qatar.
| | - Ragae Dughmosh
- Medicine Department, Hamad General Hospital, Doha, Qatar.
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute and Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Barros DSL, Silva DLMD, Leite SN. Clinical pharmaceutical services of primary health care of the Federal District: A discussion based on the SWOT matrix. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e18593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Othman MM, Khudadad H, Dughmosh R, Syed A, Clark J, Furuya-Kanamori L, Abou-Samra AB, Doi SAR. Towards a better understanding of self-management interventions in type 2 diabetes: A meta-regression analysis. Prim Care Diabetes 2021; 15:985-994. [PMID: 34217643 DOI: 10.1016/j.pcd.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/31/2021] [Accepted: 06/17/2021] [Indexed: 01/15/2023]
Abstract
AIMS Attributes that operationally conceptualize diabetes self-management education (DSME) interventions have never been studied previously to assess their impact on relevant outcomes of interest in people with type 2 diabetes (T2D). The aim of this study was to determine the impact of existing interventions classified by their delivery of skills or information related attributes on immediate (knowledge), intermediate (physical activity), post-intermediate (HbA1c), and long-term (quality of life) outcomes in people with T2D. METHODS PubMed, Embase, PsycINFO, and Cochrane Library/Cochrane CENTRAL as well as the grey literature were searched to identify interventional studies that examined the impact of DSME interventions on the four different outcomes. Eligible studies were selected and appraised independently by two reviewers. A meta-regression analysis was performed to determine the impact of delivery of the skills- and information-related attributes on the chosen outcomes. RESULTS 142 studies (n = 25,511 participants) provided data, of which 39 studies (n = 5278) reported on knowledge, 39 studies (n = 8323) on physical activity, 99 studies (n = 17,178) on HbA1c and 24 studies (n = 5147) on quality of life outcomes. Meta-regression analyses demonstrated that skills-related attributes had an estimated effect suggesting improvement in knowledge (SMD [standardized mean difference] increase of 0.80; P = 0.025) and that information-related attributes had an estimated effect suggesting improvement in quality of life (SMD increase of 0.96; P = 0.405). Skill- and information-related attributes did not have an estimated effect suggesting improvement in physical activity or in HbA1c. CONCLUSIONS The study findings demonstrate that the skills and information related attributes contribute to different outcomes for people with T2D. This study provides, for the first time, preliminary evidence for differential association of the individual DSME attributes with different levels of outcome.
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Affiliation(s)
- Manal M Othman
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Hanan Khudadad
- Department of Clinical Research, Primary Health Care Corporation, Doha, Qatar.
| | - Ragae Dughmosh
- Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Asma Syed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Justin Clark
- The Centre for Research into Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia.
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute and Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Wang X, Pang Y, Wang M, Jing J, Tang J. Clinical practice and teaching of pharmaceutical care procedures for obstetric diseases. Eur J Hosp Pharm 2021; 28:e8-e12. [PMID: 32475822 PMCID: PMC8640412 DOI: 10.1136/ejhpharm-2019-002053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Our goal was to explore the pharmaceutical service and teaching methods of obstetric clinical pharmacists to establish standardised pharmaceutical care procedures for obstetric diseases. METHODS According to the evidence-based medicine method, the "Standard of Pharmaceutical Care" was established to standardise the procedure and content of the pharmaceutical care procedure including preface, purpose, scope of application, responsibilities, procedures, references, and appendix, with seven parts in total. The object of the pharmaceutical care procedure was selected by the harmfulness of the disease and the drugs used. The clinical pharmacists in obstetrics formulated the pharmaceutical care procedure for each disease according to the standard and carried out clinical practice and teaching.A retrospective study was conducted to investigate the impact of the pharmaceutical care procedure before and after its implementation on both clinical practice and training. Obstetric pharmaceutical consultation and adverse reaction were the key indicators for clinical practice.The graduation assessment for students was strictly carried out in accordance with the regulations of the Chinese Hospital Association Pharmaceutical Affairs Professional Committee including communication and consultation capacity interview, case assessment, and training procedure assessment. RESULTS We established the standards for the pharmaceutical care procedures for three diseases: pregnancy with diabetes; pregnancy with thyroid disease; and pregnancy with hypertensive disorder. The clinical pharmacist conducted the pharmaceutical care procedure, participated in drug treatment management, and improved the recognition of the role of clinical pharmacists by the obstetric clinicians, often inviting the clinical pharmacists to participate in the consultations. The clinical pharmacists discovered and addressed any adverse reactions in a timely manner through patient drug education, subsequently reducing the underreporting of adverse reactions and improving the patient's medication compliance, which aimed to improve the medical quality of patients in our hospital. Second, the use of the pharmaceutical care procedure as a teaching tool helped to train students to grasp the key points of drug treatment and care of the disease and improve the students' scores in the graduation assessment (P<0.05). CONCLUSIONS As a pharmacy service and teaching method that can be promoted and implemented, the pharmaceutical care procedure is beneficial for clinical pharmacists to carry out in-depth pharmaceutical services and can also be used as a teaching tool for clinical pharmacist training.
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Affiliation(s)
- Xianli Wang
- Department of Pharmacy, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yanyu Pang
- Department of Pharmacy, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Mengmeng Wang
- Department of Pharmacy, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jin Jing
- Department of Pharmacy, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jing Tang
- Department of Pharmacy, The Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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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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Majeed A, Rehman M, Hussain I, Imran I, Saleem MU, Saeed H, Hashmi FK, Akbar M, Abrar MA, Ramzan B, Chaudhry MO, Islam M, Nisar N, Rasool MF. The Impact of Treatment Adherence on Quality of Life Among Type 2 Diabetes Mellitus Patients - Findings from a Cross-Sectional Study. Patient Prefer Adherence 2021; 15:475-481. [PMID: 33664567 PMCID: PMC7924113 DOI: 10.2147/ppa.s295012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/06/2021] [Indexed: 12/31/2022] Open
Abstract
AIM The current study was conducted to assess the factors contributing to treatment adherence and its impact on the quality of life (QoL) in type 2 diabetes mellitus (T2DM) patients. METHODS A cross-sectional study was conducted between January 2020 to March 2020 among T2DM patients. The data was collected from T2DM out-patient clinics. The participants were recruited by using a simple random sampling method. To assess the association of demographics with the level of adherence, binary logistics regression analysis was applied. Moreover, the Mann-Whitney U-test was used to evaluate the impact of adherence on QoL. RESULTS A total of 384 patients participated in this study. Amongst them, 60.2% were male and 39.8% were female. Low adherence was seen in illiterate patients and patients older than 40 years. The results showed that good QoL in T2DM patients was significantly associated with treatment adherence (p= 0.004). CONCLUSION The finding of the current study showed that the non-adherence prevailed in illiterate strata of the study population and the medication adherence significantly affects the QoL in T2DM patients. These findings suggest that health regulatory agencies should focus on implementing disease-education interventions for improving the adherence to medications in patients with long-term conditions.
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Affiliation(s)
- Abdul Majeed
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Iltaf Hussain
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Usman Saleem
- Department of Biosciences, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Furqan K Hashmi
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Muqarrab Akbar
- Department of Political Science, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Asad Abrar
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | | | | | - Muhammad Islam
- University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Naveed Nisar
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
- Correspondence: Muhammad Fawad Rasool Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University Multan, Multan, PakistanTel +923008639046 Email
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Maria JL, Anand TN, Dona B, Prinu J, Prabhakaran D, Jeemon P. Task-sharing interventions for improving control of diabetes in low-income and middle-income countries: a systematic review and meta-analysis. LANCET GLOBAL HEALTH 2020; 9:e170-e180. [PMID: 33242455 PMCID: PMC8279953 DOI: 10.1016/s2214-109x(20)30449-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 12/17/2022]
Abstract
Background Task-sharing interventions using non-physician health-care workers might be a potential diabetes management strategy in health systems that are constrained by physician shortages, such as those in low-income and middle-income countries (LMICs). Methods We did a systematic review and meta-analysis of task-sharing intervention strategies for managing type 2 diabetes in LMICs. We searched PubMed, Embase, and CINAHL from database inception to Sept 25, 2019, for studies that were randomised control trials or cluster randomised trials with task-shifted or task-shared interventions delivered to adults (≥18 years) by non-physician health workers versus usual care, done in LMICs with glycated haemoglobin (HbA1c) or fasting blood sugar (FBS) as outcome measures. The methodological quality of included studies was assessed using the Cochrane risk of bias tool. Random-effects model meta-analysis was used to estimate the population average pooled mean difference for HbA1c and FBS with 95% CIs. Our study protocol was registered in the PROSPERO database (CRD42018081015). Findings We found 4213 studies from the literature search, of which 46 (1·1%) were eligible for the narrative synthesis, including a total of 16 973 participants. 16 of these studies were excluded from the meta-analysis due to high risk of bias. 24 studies with a total of 5345 participants were included in the meta-analysis of HbA1c and 18 studies with a total of 3287 participants for FBS. Interventions led to an average reduction in HbA1c when tasks were delivered by nurses (averaged pooled mean difference −0·54% [95% CI −0·89 to −0·18]; I2=80%) and pharmacists (−0·91% [–1·15 to −0·68]; I2=58%), but not when they were delivered by dietitians (−0·50% [–1·10 to 0·09]; I2=54%) or community health workers (0·05% [0·03 to 0·07]; I2=0%). A reduction in average FBS was also observed when interventions were delivered by pharmacists (average pooled mean difference −36·26 mg/dL [–52·60 to −19·92]; I2=78%) but not nurses (−7·46 mg/dL [–18·44 to 3·52]; I2=79%) or community health workers (−5·41 [–12·74 to 1·92]; I2=71%). Only one study reported on FBS when tasks were delivered by dietitians, with a mean difference of −35·00 mg/dL (−65·96 to −4·04). Interpretation Task sharing interventions with non-physician healthcare workers show moderate effectiveness in diabetes management in LMIC settings. Although relatively high heterogeneity limits the interpretation of the overall findings, interventions led by pharmacists and nurses in LMICs with relatively high physician density are effective strategies in the management of diabetes. Funding Wellcome Trust–Department of Biotechnology India Alliance.
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Affiliation(s)
| | - T N Anand
- Centre for Chronic Disease Control, New Delhi, India
| | - Boban Dona
- Centre for Chronic Disease Control, New Delhi, India
| | - Jose Prinu
- Public Health Foundation of India, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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Besemah NA, Sartika RAD, Sauriasari R. Effect of Pharmacist Intervention on Medication Adherence and Clinical Outcomes of Type 2 Diabetes Mellitus Outpatients in Primary Healthcare in Indonesia. J Res Pharm Pract 2020; 9:186-195. [PMID: 33912501 PMCID: PMC8067894 DOI: 10.4103/jrpp.jrpp_20_59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE In Indonesia, the role of pharmacists in primary healthcare is still very limited or even absent. This study evaluates the effectiveness of programs delivered for type 2 diabetes mellitus (T2DM) patients by pharmacists in primary healthcare through counseling, short message service (SMS) reminders, and medication booklets. METHODS A quasi-experimental study with a pretest-posttest design was conducted from April to August 2018 at Merdeka and Dempo primary health-care centers, Palembang, South Sumatra Province, Indonesia. Counseling and medication booklets were distributed three times during the study period, while SMS reminders were sent once a week. Counseling was given for the management of diabetes mellitus (DM), including during the Ramadan fasting period, together with management for acute and chronic complications. The medication adherence level was measured using a medication adherence questionnaire (MAQ) and pill count adherence (PCA). The study sample comprised 80 T2DM patients, who were allocated into either the control group (CG) (n = 40) or intervention group (IG) (n = 40). Clinical outcomes were determined by measuring glycated hemoglobin (HbA1c), blood pressure, and lipid profiles. FINDINGS After the intervention, the IG showed significant improvements in most parameters, except for high-density lipoprotein cholesterol and systolic and diastolic blood pressure. HbA1c levels were reduced, while MAQ scores and PCA scores were improved. Lipid parameters were significantly reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglyceride (TG). Compared with the CG, most parameters were significantly improved in the IG. Pharmacist counseling significantly improved almost all clinical parameters (HbA1c, TC, LDL-c, and TG). Pharmacist counseling was 7.1 times greater in lowering HbA1c compared with no counseling, after adjusted by other variables. The variable that most influenced the lowering of HbA1c was infrequent ("not often") consumption of unhealthy foods (OR 14.9; 95% CI 3.5-63.7). CONCLUSION The pharmacist primary health-care intervention program implemented in this study significantly improved HbA1c, TC, LDL-c, TG, and medication adherence in outpatients with T2DM.
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Affiliation(s)
- Nani Apriani Besemah
- Department of Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia
| | - Ratu Ayu Dewi Sartika
- Department of Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia
| | - Rani Sauriasari
- Department of Public Health Nutrition, Public Health Faculty, Universitas Indonesia, Depok, Indonesia
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Pousinho S, Morgado M, Plácido AI, Roque F, Falcão A, Alves G. Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review. Pharm Pract (Granada) 2020; 18:2000. [PMID: 32922572 PMCID: PMC7470242 DOI: 10.18549/pharmpract.2020.3.2000] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/16/2020] [Indexed: 11/14/2022] Open
Abstract
Background Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements. Objective This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes. Methods PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities. Results This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m2 to -1.94 kg/m2; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable. Conclusions These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes.
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Affiliation(s)
- Sarah Pousinho
- MSC. CICS-UBI - Health Sciences Research Centre, University of Beira Interior. Covilhã (Portugal).
| | - Manuel Morgado
- PhD, PharmD. CICS-UBI - Health Sciences Research Centre, University of Beira Interior. Covilhã (Portugal).
| | - Ana I Plácido
- PhD. Research Unit for Inland Development, Polytechnic of Guarda (UDI-IPG). Guarda (Portugal).
| | - Fátima Roque
- PhD, PharmD. CICS-UBI - Health Sciences Research Centre, University of Beira Interior. Covilhã (Portugal).
| | - Amílcar Falcão
- PhD, PharmD. Centre for Neuroscience and Cell Biology, Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra. Coimbra (Portugal).
| | - Gilberto Alves
- PhD, PharmD. CICS-UBI - Health Sciences Research Centre, University of Beira Interior. Covilhã (Portugal).
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Al-Taie A, Izzettin FV, Sancar M, Köseoğlu A. Impact of clinical pharmacy recommendations and patient counselling program among patients with diabetes and cancer in outpatient oncology setting. Eur J Cancer Care (Engl) 2020; 29:e13261. [PMID: 32537812 DOI: 10.1111/ecc.13261] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 12/10/2019] [Accepted: 04/16/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The simultaneous occurrence of diabetes and cancer may complicate the management of both conditions resulting in poor prognosis and more deterioration of patient-related outcomes. OBJECTIVE To assess the effective provision of clinical pharmacy services and pharmacist-led counselling program on improving patient-related outcomes among patients with diabetes and newly diagnosed with cancer during chemotherapy administration. METHODS A single-centre, prospective, randomised, controlled study was carried out on patients with diabetes newly diagnosed with cancer during chemotherapy administration at the outpatient oncology setting. Patients were assigned as a normal care group receiving only normal care by the oncology care providers and an intervention group receiving both normal and clinical pharmacy care through an extensive oral and written patient education, pharmacotherapy optimisation and regular recommendations for diabetic self-care activities with three-month follow-up. RESULTS Patients within the intervention group showed a better glycaemic control (p = .049), a significant increase in medication adherence (p = .0049), a significant increase in diabetes self-care activities, including diet (p = .037), self-monitoring of blood glucose (p = .027) and foot care (p = .0085) and reported a lower deterioration in quality of life. CONCLUSION Patients with diabetes and cancer receiving chemotherapy experienced improved patient-related outcomes after clinical pharmacy intervention and counselling program compared to the normal care group.
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Affiliation(s)
- Anmar Al-Taie
- Faculty of Pharmacy, Pharmacy Department, Girne American University, Kyrenia, North Cyprus, Turkey
| | - Fikret V Izzettin
- Faculty of Pharmacy, Clinical Pharmacy Department, Bezmialem Vakıf University, Istanbul, Turkey
| | - Mesut Sancar
- Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey
| | - Aygül Köseoğlu
- Oncology Centre, Dr. Lütfi Kırdar Kartal Teaching and Research Hospital, Istanbul, Turkey
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Lin G, Huang R, Zhang J, Li G, Chen L, Xi X. Clinical and economic outcomes of hospital pharmaceutical care: a systematic review and meta-analysis. BMC Health Serv Res 2020; 20:487. [PMID: 32487066 PMCID: PMC7268541 DOI: 10.1186/s12913-020-05346-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/20/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hospital clinical pharmacists have been working in many countries for many years and clinical pharmaceutical care have a positive effect on the recovery of patients. In order to evaluate the clinical effectiveness and economic outcomes of clinical pharmaceutical care, relevant clinical trial studies were reviewed and analysed. METHODS Two researchers searched literatures published from January 1992 to October 2019, and screened them by keywords like pharmaceutical care, pharmaceutical services, pharmacist interventions, outcomes, effects, impact, etc. Then, duplicate literatures were removed and the titles, abstracts and texts were read to screen literatures according to inclusion and exclusion criteria. Key data in the literature were extracted, and Meta-analysis was conducted using the literature with common outcome indicators. RESULTS A total of 3299 articles were retrieved, and 42 studies were finally included. Twelve of them were used for meta-analysis. Among the 42 studies included, the main results of pharmaceutical care showed positive effects, 36 experimental groups were significantly better than the control group, and the remaining 6 studies showed mixed or no effects. Meta-analysis showed that clinical pharmacists had significant effects on reducing systolic blood pressure and diastolic blood pressure and shortening hospitalization days (P < 0.05), but no statistical significance in reducing medical costs (P > 0.05). CONCLUSION Clinical pharmacists' pharmaceutical care has a significant positive effect on patients' clinical effects, but has no significant economic effect.
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Affiliation(s)
- Guohua Lin
- China Pharmaceutical University, Nanjing, China
| | - Rong Huang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China
| | - Jing Zhang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China
| | - Gaojie Li
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China
| | - Lei Chen
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, No.639 longmian Avenue, Jiangning District, Nanjing, 211198, China.
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Nogueira M, Otuyama LJ, Rocha PA, Pinto VB. Pharmaceutical care-based interventions in type 2 diabetes mellitus : a systematic review and meta-analysis of randomized clinical trials. EINSTEIN-SAO PAULO 2020; 18:eRW4686. [PMID: 32022107 PMCID: PMC6986882 DOI: 10.31744/einstein_journal/2020rw4686] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 09/02/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate the impact of pharmaceutical care-based interventions on type 2 diabetes mellitus . METHODS PubMed®, Cochrane and Web of Science data bases were searched for randomized controlled clinical trials. Studies evaluating pharmaceutical care-based interventions in type 2 diabetes mellitus published between 2012 and 2017 were included. Glycated hemoglobin was defined as the primary endpoint; blood pressure, triglycerides and cholesterol as secondary endpoints. The random effects model was used in meta-analysis. RESULTS Fifteen trials involving 2,325 participants were included. Meta-analysis revealed considerable heterogeneity (I2>97%; p<0.001), reduction in glycated hemoglobin (-1.07%; 95%CI: -1.32; -0.83; p<0.001), glucose (-29.91mg/dL; 95%CI: -43.2; -16.6; p<0.001), triglyceride (19.8mg/dL; 95%CI: -36.6; -3.04; p=0.021), systolic blood pressure (-4.65mmHg; 95%CI: -8.9; -0.4; p=0.032) levels, and increased HDL levels (4.43mg/dL; 95%CI: 0.16; 8.70; p=0.042). CONCLUSION Pharmaceutical care-based clincal and education interventions have significant impact on type 2 diabetes mellitus . The tools Summary of Diabetes Self-Care Activities and the Morisky Medication Adherence Scale may be useful to monitor patients.
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Affiliation(s)
- Marcel Nogueira
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazilHospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Leonardo Jun Otuyama
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazilHospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Priscilla Alves Rocha
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazilHospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Vanusa Barbosa Pinto
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazilHospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Martínez-Mardones F, Fernandez-Llimos F, Benrimoj SI, Ahumada-Canale A, Plaza-Plaza JC, S Tonin F, Garcia-Cardenas V. Systematic Review and Meta-Analysis of Medication Reviews Conducted by Pharmacists on Cardiovascular Diseases Risk Factors in Ambulatory Care. J Am Heart Assoc 2019; 8:e013627. [PMID: 31711390 PMCID: PMC6915276 DOI: 10.1161/jaha.119.013627] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Pharmacists‐led medication reviews (MRs) are claimed to be effective for the control of cardiovascular diseases; however, the evidence in the literature is conflicting. The main objective of this meta‐analysis was to analyze the impact of pharmacist‐led MRs on cardiovascular disease risk factors overall and in different ambulatory settings while exploring the effects of different components of MRs. Methods and Results Searches were conducted in PubMed, Web of Science, Embase, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library Central Register of Controlled Trials database. Randomized and cluster randomized controlled trials of pharmacist‐led MRs compared with usual care were included. Settings were community pharmacies and ambulatory clinics. The classification used for MRs was the Pharmaceutical Care Network Europe as basic (type 1), intermediate (type 2), and advanced (type 3). Meta‐analyses in therapeutic goals used odds ratios to standardize the effect of each study, and for continuous data (eg, systolic blood pressure) raw differences were calculated using baseline and final values, with 95% CIs. Prediction intervals were calculated to account for heterogeneity. Sensitivity analyses were conducted to test the robustness of results. Meta‐analyses included 69 studies with a total of 11 644 patients. Sample demographic characteristics were similar between studies. MRs increased control of hypertension (odds ratio, 2.73; 95% prediction interval, 1.05–7.08), type 2 diabetes mellitus (odds ratio, 3.11; 95% prediction interval, 1.17–5.88), and high cholesterol (odds ratio, 1.91; 95% prediction interval, 1.05–3.46). In ambulatory clinics, MRs produced significant effects in control of diabetes mellitus and cholesterol. For community pharmacies, systolic blood pressure and low‐density lipoprotein values decreased significantly. Advanced MRs had larger effects than intermediate MRs in diabetes mellitus and dyslipidemia outcomes. Most intervention components had no significant effect on clinical outcomes and were often poorly described. CIs were significant in all analyses but prediction intervals were not in continuous clinical outcomes, with high heterogeneity present. Conclusions Intermediate and advanced MRs provided by pharmacists may improve control of blood pressure, cholesterol, and type 2 diabetes mellitus, as statistically significant prediction intervals were found. However, most continuous clinical outcomes failed to achieve statistical significance, with high heterogeneity present, although positive trends and effect sizes were found. Studies should use a standardized method for MRs to diminish sources of these heterogeneities.
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Affiliation(s)
| | - Fernando Fernandez-Llimos
- Institute for Medicines Research (iMed.ULisboa) Department of Social Pharmacy Faculty of Pharmacy University of Lisbon Portugal
| | - Shalom I Benrimoj
- Member of the Pharmaceutical Care Research Group University of Granada Faculty of Pharmacy Campus Universitario Cartuja Granada Spain
| | | | | | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Programme Federal University of Paraná Curitiba Brazil
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Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis. Res Social Adm Pharm 2019; 15:1057-1067. [DOI: 10.1016/j.sapharm.2018.09.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/21/2018] [Accepted: 09/29/2018] [Indexed: 11/20/2022]
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Hening WN, Sartika RAD, Sauriasari R. Effect of Hospital Pharmacist Counseling on Clinical Outcomes of Type 2 Diabetes Mellitus Outpatients. J Res Pharm Pract 2019; 8:155-161. [PMID: 31728347 PMCID: PMC6830025 DOI: 10.4103/jrpp.jrpp_19_67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022] Open
Abstract
Objective: In Indonesia, the role of a hospital pharmacist in pharmaceutical care is still limited or even absent. This study aimed to determine whether counseling by a pharmacist could improve medication adherence, controlling the glycemic status, lipid profile, and blood pressure of type 2 diabetes mellitus (T2DM) outpatients. Methods: We conducted an interventional study at RSUD Kota Depok, a secondary public hospital, Indonesia, from April to October 2018. Counseling was given three times during the 4-month study. The study design was quasi-experimental with pretest-posttest group design on 77 respondents divided into intervention group (IGs) (n = 39 people) who received counseling and booklets from the hospital pharmacist and control group (CG) (n = 38 people) who were only given the booklets. We measured adherence with the Medication Adherence Questionnaire and conducted blood tests for fasting blood glucose (FBG), postprandial blood glucose (PPBG), glycosylated hemoglobin A1, lipid profiles (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and TG), and blood pressure measurements. Findings: In the IG, adherence parameters such as HbA1c and lipid profile improved, whereas in the CG, there were no statistically significant changes in clinical parameters and even nonadherence score increased (P = 0.008). IG showed statistically significant improvement in medication adherence, in parameters such as FBG, PPBG, and HbA1c, compared to CG. Based on the Chi-square test, IG also showed a statistically significant improvement in the number of controlled FBG (P = 0.05) and HbA1c (P < 0.001) compared to CG. In addition, a multivariate analysis showed that counseling by hospital pharmacist was 2.764 times (95% confidence interval [CI]: 1.096–6.794) and 9.964 times (95% CI: 3.434–28.917) better than no counseling in improvement of FBG and HbA1c, respectively. However, the significance disappeared after adjusted by type of medicine, duration of diabetes mellitus drug use, and medication adherence. Conclusion: Hospital pharmacist counseling is an important and significant factor in improving FBG and HbA1c levels of T2DM outpatients.
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Affiliation(s)
| | - Ratu Ayu Dewi Sartika
- Department of Public Health Nutrition, Public Health Faculty, Universitas Indonesia, Depok, Indonesia
| | - Rani Sauriasari
- Department of Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, Indonesia
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Baral SR, Parajuli DR, Shrestha S, Acharya SR, Dahal P, Poudel P, Ghimire S, Palaian S, Shrestha N. Undergraduate pharmacy students' attitudes and perceived barriers toward provision of pharmaceutical care: a multi-institutional study in Nepal. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2019; 8:47-59. [PMID: 31240200 PMCID: PMC6556473 DOI: 10.2147/iprp.s203240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/26/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Pharmaceutical care (PC) has a significant impact on optimizing pharmacotherapy and improving patients’ quality of life. We aimed to determine the attitudes and perceived barriers of final year pharmacy undergraduates towards provision of PC services in Nepal. Methods: A cross-sectional study was conducted among 232 students using a 13-item-standard PC attitude survey (PCAS) questionnaire and 12-itemed PC barrier questionnaires. Mann–Whitney U test and Kruskal–Wallis tests were used to measure the median difference between groups, at alpha=0.05, and Spearman’s rho test was used to measure the strength of the correlation. Results: Majority of students were self-motivated in undertaking the current pharmacy education (178, 76.7%) and had no previous incomplete grades that could delay their graduation (177, 76.3%). Over 80% of students had a positive attitude toward all items of PCAS (agreed and strongly agreed) except for two items. Whereas, 61 (26.3%) disagreed and strongly disagreed that providing PC takes too much time and effort. The major barriers perceived were inadequate PC training (176, 75.9%), inadequate drug information resources in the pharmacy (170, 73.3%), and lack of access to patient medical records in the pharmacy (165, 71.1%). A significant relationship was noticed between positive attitude towards PC and three factors; source of motivation, current employment in pharmacy job, and incomplete grades delaying graduation. Age factor was significant but negatively correlated with the scores of positive attitudes namely “I would like to perform PC as a pharmacist practitioner”, “Providing PC is professionally rewarding” and “I feel that the PC is the right direction for the provision to be headed”. Conclusion: Nepalese undergraduate pharmacy students had positive attitudes toward PC. Exercising proper pharmacy practice regulations and educational efforts to overcome the perceived barriers may lead to better delivery of PC.
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Affiliation(s)
- Sanjay Raj Baral
- Department of Pharmacy and Pharmacology, Chitwan Medical College, Bharatpur-10, Chitwan, Nepal
| | - Daya Ram Parajuli
- School of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Shakti Shrestha
- School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | | | - Prasanna Dahal
- Department of Pharmacy, College of Medical and Allied Sciences, Purbanchal University, Gothgaun, Morang, Nepal
| | | | - Saruna Ghimire
- Department of Pharmacy, Valley College of Technical Sciences, Kathmandu, Nepal
| | - Subish Palaian
- College of Pharmacy, Gulf Medical University, Ajman, UAE
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24
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Anand TN, Joseph LM, Geetha AV, Prabhakaran D, Jeemon P. Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 2019; 7:e761-e771. [PMID: 31097278 PMCID: PMC6527522 DOI: 10.1016/s2214-109x(19)30077-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/22/2019] [Accepted: 02/08/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and resource-poor health systems. We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries. METHODS We searched the Cochrane Library, PubMed, Embase, and CINAHL for studies published up to December 2018. We included intervention studies involving a task-sharing strategy for management of blood pressure and other cardiovascular risk factors. We extracted data on population, interventions, blood pressure, and task sharing groups. We did a meta-analysis of randomised controlled trials. FINDINGS We found 3012 references, of which 54 met the inclusion criteria initially. Another nine studies were included following an updated search. There were 43 trials and 20 before-and-after studies. We included 31 studies in our meta-analysis. Systolic blood pressure was decreased through task sharing in different groups of health-care workers: the mean difference was -5·34 mm Hg (95% CI -9·00 to -1·67, I2=84%) for task sharing with nurses, -8·12 mm Hg (-10·23 to -6·01, I2=57%) for pharmacists, -4·67 mm Hg (-7·09 to -2·24, I2=0%) for dietitians, -3·67 mm Hg (-4·58 to -2·77, I2=24%) for community health workers, and -4·85 mm Hg (-6·12 to -3·57, I2=76%) overall. We found a similar reduction in diastolic blood pressure (overall mean difference -2·92 mm Hg, -3·75 to -2·09, I2=80%). The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure, but low for diastolic blood pressure. INTERPRETATION Task-sharing interventions are effective in reducing blood pressure. Long-term studies are needed to understand their potential impact on cardiovascular outcomes and mortality. FUNDING Wellcome Trust/DBT India Alliance.
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Affiliation(s)
- T N Anand
- Centre for Chronic Disease Control, New Delhi, India
| | | | - A V Geetha
- Public Health Foundation of India, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene & Tropical Medicine, London, UK
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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25
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Goruntla N, Mallela V, Nayakanti D. Impact of Pharmacist-directed Counseling and Message Reminder Services on Medication Adherence and Clinical Outcomes in Type 2 Diabetes Mellitus. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2019; 11:69-76. [PMID: 30906142 PMCID: PMC6394155 DOI: 10.4103/jpbs.jpbs_211_18] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Medication nonadherence is the most common issue observed in the management of diabetes because of complex and lifelong therapy. The study aimed to assess the effect of pharmacist-directed counseling and daily text message reminder on medication adherence and clinical profile of patients with type II diabetes. Materials and Methods: This prospective, open-labeled, randomized control trial was carried out in outpatient medical department of a secondary care referral hospital. A total of 330 patients who met study criteria were enrolled and randomized into an intervention group (n = 165), received counseling and daily messages about medication intake and control group (n = 165), and usual care by physician. Medication adherence and clinical outcomes such as glycosylated hemoglobin (HbA1C), systolic blood pressure (SBP), low-density lipoprotein (LDL) cholesterol, triglyceride (TG) levels, and body mass index (BMI) were recorded at baseline and follow-up visits. Two-sample Wilcoxon rank sum test was used to compare the mean difference of medication adherence and paired t-test was used to compare clinical outcomes. Results and Discussion: The mean age of intervention and control groups were 57.1 ± 8.55 and 58.5 ± 8.53 years, respectively. The mean difference of medication adherence from baseline to second follow-up visit was significantly more in intervention group (12.2 ± 7.1%) compared to that in control group (0.75 ± 10.2 %) with a P < 0.001. From baseline to second follow-up visit, HbA1C (7.79 ± 0.67 to 6.91 ± 0.83 %), SBP (136.75 ± 20.09 to 126.23 ± 18.22 mm Hg), and LDL cholesterol (104.14 ± 26.23 to 98.29 ± 20.87 mg/dL) levels were significantly reduced in intervention group compared to that in control group with a P < 0.01. No significant improvement was observed in TG (169± 33.71 to 168 65 ± 33.90 mg/dL) and BMI (27.9 ± 4.21 to 27.1 ± 3.12 Kg/m2) levels from baseline to second follow-up visit. Conclusion: Pharmacist-directed patient counseling combined with message reminder showed a greater effect on the improvement of medication adherence and control of glycemia, blood pressure, and lipid profile in diabetes.
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Affiliation(s)
- Narayana Goruntla
- Research Department of Pharmaceutical Sciences, Jawaharlal Nehru Technological University Anantapur, Ananthapuramu, Andhra Pradesh, India
| | - Vijayajyothi Mallela
- Department of Pharmaceutical Chemistry, Raghavendra Institute of Pharmaceutical Education and Research (RIPER), Ananthapuramu, Andhra Pradesh, India
| | - Devanna Nayakanti
- Department of Chemistry, Jawaharlal Nehru Technological University Anantapur, Ananthapuramu, Andhra Pradesh, India
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26
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Iqbal MZ, Khan AH, Iqbal MS, Syed Sulaiman SA. A Review of Pharmacist-led Interventions on Diabetes Outcomes: An Observational Analysis to Explore Diabetes Care Opportunities for Pharmacists. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2019; 11:299-309. [PMID: 31619911 PMCID: PMC6791080 DOI: 10.4103/jpbs.jpbs_138_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A strict and adherence treatment is required by the patient with diabetes mellitus and it demands a proper self-medication by the patient. Pharmacists are involved in providing self-management support to the patients. This review evaluates the interventions of pharmacist for patients to improve self-management with diabetes mellitus and also to improve the clinical outcomes of diabetes mellitus. A comprehensive literature search was performed by using different keywords "pharmacist-led intervention," "diabetes," "effect of pharmacist on outcome of diabetes," and "self-management of diabetes" with the help of various electronic databases such as PubMed, Science Direct, Embase, Web of Science, and the Cochrane Library from the beginning of the database through September 2018. The primary outcome was glycated hemoglobin (HbA1c), whereas the secondary outcomes were blood glucose level, blood pressure (BP) measure, body mass index, lipids, adherence to medication, and quality of life. Twenty-five studies comprising 2997 diabetic patients were included in the analysis. Pharmacist-led intervention was involved in all included studies in the form of education on diabetes and its complications, medication adherence, lifestyle, and education about self-management skills. Pharmacist-led interventions are able to reduce HbA1c levels with a mean of 0.75%. Most studies do not expose the material and methods used in pharmacist-led intervention. The variation in the reduction of HbA1c, fasting blood sugar, BP, and lipid profile was due to the lack of this standardization. The included studies indicated that pharmacist-led interventions in diabetes mellitus can significantly improve the outcomes of diabetes mellitus and its complication later on. Hence, these long-term improvements in outcomes added more value of pharmacists in health-care system of the world.
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Affiliation(s)
- Muhammad Z Iqbal
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.,Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, AIMST University Malaysia, Bedong, Kedah Darul Aman, Malaysia
| | - Amer Hayat Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Muhammad S Iqbal
- Associate Professor, Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia
| | - Syed Azhar Syed Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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27
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Fixen DR, Linnebur SA, Parnes BL, Vejar MV, Vande Griend JP. Development and economic evaluation of a pharmacist-provided chronic care management service in an ambulatory care geriatrics clinic. Am J Health Syst Pharm 2018; 75:1805-1811. [DOI: 10.2146/ajhp170723] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Danielle R. Fixen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | - Sunny A. Linnebur
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | - Bennett L. Parnes
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO
| | - Maria V. Vejar
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO
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28
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de Barra M, Scott CL, Scott NW, Johnston M, de Bruin M, Nkansah N, Bond CM, Matheson CI, Rackow P, Williams AJ, Watson MC. Pharmacist services for non-hospitalised patients. Cochrane Database Syst Rev 2018; 9:CD013102. [PMID: 30178872 PMCID: PMC6513292 DOI: 10.1002/14651858.cd013102] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND This review focuses on non-dispensing services from pharmacists, i.e. pharmacists in community, primary or ambulatory-care settings, to non-hospitalised patients, and is an update of a previously-published Cochrane Review. OBJECTIVES To examine the effect of pharmacists' non-dispensing services on non-hospitalised patient outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases and two trial registers in March 2015, together with reference checking and contact with study authors to identify additional studies. We included non-English language publications. We ran top-up searches in January 2018 and have added potentially eligible studies to 'Studies awaiting classification'. SELECTION CRITERIA Randomised trials of pharmacist services compared with the delivery of usual care or equivalent/similar services with the same objective delivered by other health professionals. DATA COLLECTION AND ANALYSIS We used standard methodological procedures of Cochrane and the Effective Practice and Organisation of Care Group. Two review authors independently checked studies for inclusion, extracted data and assessed risks of bias. We evaluated the overall certainty of evidence using GRADE. MAIN RESULTS We included 116 trials comprising 111 trials (39,729 participants) comparing pharmacist interventions with usual care and five trials (2122 participants) comparing pharmacist services with services from other healthcare professionals. Of the 116 trials, 76 were included in meta-analyses. The 40 remaining trials were not included in the meta-analyses because they each reported unique outcome measures which could not be combined. Most trials targeted chronic conditions and were conducted in a range of settings, mostly community pharmacies and hospital outpatient clinics, and were mainly but not exclusively conducted in high-income countries. Most trials had a low risk of reporting bias and about 25%-30% were at high risk of bias for performance, detection, and attrition. Selection bias was unclear for about half of the included studies.Compared with usual care, we are uncertain whether pharmacist services reduce the percentage of patients outside the glycated haemoglobin target range (5 trials, N = 558, odds ratio (OR) 0.29, 95% confidence interval (CI) 0.04 to 2.22; very low-certainty evidence). Pharmacist services may reduce the percentage of patients whose blood pressure is outside the target range (18 trials, N = 4107, OR 0.40, 95% CI 0.29 to 0.55; low-certainty evidence) and probably lead to little or no difference in hospital attendance or admissions (14 trials, N = 3631, OR 0.85, 95% CI 0.65 to 1.11; moderate-certainty evidence). Pharmacist services may make little or no difference to adverse drug effects (3 trials, N = 590, OR 1.65, 95% CI 0.84 to 3.24) and may slightly improve physical functioning (7 trials, N = 1329, mean difference (MD) 5.84, 95% CI 1.21 to 10.48; low-certainty evidence). Pharmacist services may make little or no difference to mortality (9 trials, N = 1980, OR 0.79, 95% CI 0.56 to 1.12, low-certaintly evidence).Of the five studies that compared services delivered by pharmacists with other health professionals, no studies evaluated the impact of the intervention on the percentage of patients outside blood pressure or glycated haemoglobin target range, hospital attendance and admission, adverse drug effects, or physical functioning. AUTHORS' CONCLUSIONS The results demonstrate that pharmacist services have varying effects on patient outcomes compared with usual care. We found no studies comparing services delivered by pharmacists with other healthcare professionals that evaluated the impact of the intervention on the six main outcome measures. The results need to be interpreted cautiously because there was major heterogeneity in study populations, types of interventions delivered and reported outcomes.There was considerable heterogeneity within many of the meta-analyses, as well as considerable variation in the risks of bias.
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Affiliation(s)
- Mícheál de Barra
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Claire L Scott
- NHS Education for ScotlandScottish Dental Clinical Effectiveness ProgrammeDundee Dental Education CentreSmall's WyndDundeeUKDD1 4HN
| | - Neil W Scott
- University of AberdeenMedical Statistics TeamPolwarth BuildingForesterhillAberdeenScotlandUKAB 25 2 ZD
| | - Marie Johnston
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Marijn de Bruin
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - Nancy Nkansah
- University of CaliforniaClinical Pharmacy155 North Fresno Street, Suite 224San FranciscoCaliforniaUSA93701
| | - Christine M Bond
- University of AberdeenDivision of Applied Health SciencesPolwarth BuildingForesterhillAberdeenUKAB25 2ZD
| | | | - Pamela Rackow
- University of AberdeenInstitute of Applied Health SciencesAberdeenUK
| | - A. Jess Williams
- Nottingham Trent UniversitySchool of PsychologyNottinghamEnglandUK
| | - Margaret C Watson
- University of BathDepartment of Pharmacy and Pharmacology5w 3.33Claverton DownBathUKBA2 7AY
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29
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Bukhsh A, Khan TM, Lee SWH, Lee LH, Chan KG, Goh BH. Efficacy of Pharmacist Based Diabetes Educational Interventions on Clinical Outcomes of Adults With Type 2 Diabetes Mellitus: A Network Meta-Analysis. Front Pharmacol 2018; 9:339. [PMID: 29692730 PMCID: PMC5902757 DOI: 10.3389/fphar.2018.00339] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Comparative efficacy of different pharmacist based interventions on glycemic control of type 2 diabetes patients is unclear. This review aimed to evaluate and compare the efficacy of different pharmacist based interventions on clinical outcomes of type 2 diabetes patients. Methods: A systematic search was conducted across five databases from date of database inception to September 2017. All randomized clinical trials evaluating the efficacy of pharmacist based interventions on type 2 diabetes patients were included for network meta-analysis (NMA). The protocol is available with PROSPERO (CRD42017078854). Results: A total of 43 studies, involving 6259 type 2 diabetes patients, were included. NMA demonstrated that all interventions significantly lowered glycosylated hemoglobin (HbA1c) levels compared to usual care, but there was no statistical evidence from this study that one intervention was significantly better than the other for reducing HbA1c levels. Pharmacist based diabetes education plus pharmaceutical care showed maximum efficacy for reducing HbA1c levels [-0.86, 95% CI -0.983, -0.727; p < 0.001]. Pharmacist based diabetes education plus pharmaceutical care was observed to be statistically significant in lowering levels of systolic blood pressure [-4.94; 95%CI -8.65, -1.23] and triglycerides levels [-0.26, 95%CI -0.51, -0.01], as compared to the interventions which involved diabetes education by pharmacist, and for body mass index (BMI) [-0.57; 95%CI -1.25, -0.12] in comparison to diabetes education by health care team involving pharmacist as member. Conclusion: The findings of this review demonstrate that all interventions had a significantly positive effect on HbA1c, but there was no statistical evidence from this study that one intervention was significantly better than the other for achieving glycemic control.Pharmacist based diabetes education plus pharmaceutical care showed maximum efficacy on HbA1c and rest of the clinical outcomes.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Tahir M Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Shaun W H Lee
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | - Learn-Han Lee
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Bandar Sunway, Malaysia.,Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Center of Health Outcomes Research and Therapeutic Safety, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Kok-Gan Chan
- International Genome Centre, Jiangsu University, Zhenjiang, China.,Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Bandar Sunway, Malaysia.,Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,Center of Health Outcomes Research and Therapeutic Safety, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
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30
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van Eikenhorst L, Taxis K, van Dijk L, de Gier H. Pharmacist-Led Self-management Interventions to Improve Diabetes Outcomes. A Systematic Literature Review and Meta-Analysis. Front Pharmacol 2017; 8:891. [PMID: 29311916 PMCID: PMC5735079 DOI: 10.3389/fphar.2017.00891] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/21/2017] [Indexed: 01/09/2023] Open
Abstract
Background: Treatment of diabetes requires a strict treatment scheme which demands patient self-management. Pharmacists are in a good position to provide self-management support. This review examines whether pharmacist-led interventions to support self-management in diabetes patients improve clinical and patient-reported outcomes. Methods: This review was conducted according to the PRISMA guidelines. An extended literature search was conducted with the keywords "pharmacist," "diabetes," and "self-management" using the electronic databases Pubmed, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Library from the beginning of the database through September 2017. In addition reference lists of systematic reviews and included studies were searched. Eligibility criteria included; self-management intervention tested with an RCT, performed in an ambulatory care setting, led by a pharmacist and reporting at least one clinical- or patient-reported outcome. Primary outcomes were HbA1c (-as this is a clinical parameter for long-term diabetes follow-up), self-management and components of intervention. Secondary outcomes were blood glucose, blood pressure, BMI, lipids, adherence to medication, quality of life, and diabetes knowledge. For the meta-analysis HbA1c values were pooled with a random-effects model in Revman 5.3. Risk of bias was assessed with the Cochrane Risk of Bias tool. Results: Twenty-four studies representing 3,610 patients were included. Pharmacist-led self-management interventions included education on diabetes complications, medication, lifestyle, and teaching of self-management skills. Some studies focused on patient needs through a tailored intervention. No key components for a successful self-management intervention could be identified. Pharmacist-led self-management interventions improve HbA1c levels with a mean of 0.71% (CI -0.91, -0.51; overall effect P < 0.0001) and had a positive effect on blood pressure (SBP -5.20 mm Hg [-7.58; -2.92], DBP -3.51 mmHg [-6.00; -1.01]), BMI (-0.49 kg/m2 [-0.79; -0.19]), lipids (total cholesterol -0.19 mmol/l [-0.33; -0.05], LDL-C mmol/l -0.16 [-0.26; -0.06], HDL-C 0.32 mmol/l [0.02; 0.61]), self-management skill development, and adherence to medication. Conclusion: Pharmacist-led self-management interventions significantly improve HbA1c values in diabetes patients. These results underline the added value of pharmacists in patient-related care. Pharmacists should offer self-management support to diabetes patients in order to improve diabetes outcomes.
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Affiliation(s)
- Linda van Eikenhorst
- Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Liset van Dijk
- Pharmaceutical Care, NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Han de Gier
- Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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