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Fougère E, Delavaud JM, Filloux C, Danigo A, Fagnère C, Jost J, Teissier MP, Demiot C. [Interest of a short educational intervention coordinated by community pharmacists for elderly type 2 diabetes patients in a rural area]. Therapie 2024:S0040-5957(24)00006-4. [PMID: 38341320 DOI: 10.1016/j.therap.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
The number of elderly people with type 2 diabetes (T2D) is increasing worldwide. Community pharmacies, thanks to their proximity, provide more easy access to therapeutic education for rural patients. Populations living in isolated areas require specific educational resources related to their condition. The aim of this project was to perform a short (FLASH) educational intervention, coordinated by community pharmacists, and then evaluate the impact of this intervention on patient knowledge of their disease. The study was performed in Issoudun, a rural French town of approximately 10,000 inhabitants. Educational priorities were defined and the project was presented to health authorities and local health professionals. Pharmacies in Issoudun recruited patients, either alone or accompanied by their caregivers. The educational intervention lasted 2h and focused on 4 teaching objectives: knowledge concerning diabetes, diabetic complications and how to monitor them; how to react to hypoglycemia; understanding treatments; and understanding glycated hemoglobin. The impact of this educational intervention was assessed using a questionnaire delivered before the intervention, immediately after, and after 6months. Forty-five patients aged 71±6years with T2D duration of 14±6years were recruited over 6months. Some false beliefs were identified before the intervention. The educational session led to a significant improvement in the percentage of correct answers (before: 60.3%±7.5, after: 99%±0.4, P=0.0002) and at 6months (99.5%±0.3, P=0.0002) compared with the patients' initial knowledge. Almost all false beliefs were corrected by the intervention and patients were able to recall the mechanism of action of their drugs, with the help of a "key and lock" schematic. This short FLASH educational intervention, coordinated by community pharmacists, showed that the model was both interesting to patients and effective. This method could be expanded to other rural communities and medical deserts.
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Affiliation(s)
- Edouard Fougère
- Service de chimie thérapeutique, faculté de pharmacie, université de Limoges, 87025 Limoges, France
| | - Jean-Michel Delavaud
- Unité transversale territoriale d'éducation du patient de Haute-Vienne, centre hospitalier universitaire, 87042 Limoges, France
| | - Claire Filloux
- Service de pharmacologie, toxicologie et pharmacovigilance, centre hospitalier universitaire, 87042 Limoges, France
| | - Aurore Danigo
- UR 20218-NeurIT, facultés de médecine et pharmacie, université de Limoges, 87025 Limoges, France
| | - Catherine Fagnère
- Service de chimie thérapeutique, faculté de pharmacie, université de Limoges, 87025 Limoges, France
| | - Jérémy Jost
- Service de chimie thérapeutique, faculté de pharmacie, université de Limoges, 87025 Limoges, France; Service pharmacie, centre hospitalier universitaire, 87042 Limoges, France
| | - Marie-Pierre Teissier
- Service d'endocrinologie, diabète et maladies métaboliques, centre hospitalier universitaire, 87042 Limoges, France
| | - Claire Demiot
- UR 20218-NeurIT, facultés de médecine et pharmacie, université de Limoges, 87025 Limoges, France; Service pharmacie, centre hospitalier universitaire, 87042 Limoges, France.
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Emeka PM, AlMunjem MF, Rasool ST, Kamil N. Evaluation of Counseling Practices and Patient's Satisfaction Offered by Pharmacists for Diabetics Attending Outpatient Pharmacies in Al Ahsa. J Patient Exp 2019; 7:338-345. [PMID: 32821793 PMCID: PMC7410136 DOI: 10.1177/2374373519846945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Patient counseling can be helpful in improving the outcome of disease management, particularly chronic diseases such as diabetes mellitus, which is common in Saudi Arabia. The present study looks to investigate the levels of counseling and satisfaction among patients attending diabetic clinics in outpatient hospital pharmacy in Al Ahsa, Saudi Arabia. Method This is a cross-sectional investigation, carried out by using interview-structured questionnaire, targeting diabetes mellitus patients with or without comorbid states. The questionnaire was divided into 3 parts comprising of demographics, counseling types given while collecting prescription, and satisfaction rating of services provided. Result More males than females participated; most of whom were college graduates older than 51 years. Sixty-three percent of the entire participants are type 1 diabetic patients, while 37% are type 2 diabetes mellitus patients. Coexistence of hypercholesterolemia was higher among type 1 diabetes patients with 51.9%, while hypertension was more common among type 2 diabetic patients representing 68.2%. Findings also showed that counseling was provided for medication use among type 1 diabetic patients but was deficient in the case of type 2 diabetic patients. Patients received low level of counseling on side effects and healthy lifestyle living. Satisfaction level was only 11.1%, indicating that counseling services might be deficient. Conclusion This study has revealed poor counseling practices and low satisfaction levels in services provided by outpatient hospital pharmacies to diabetic patients. In the face of increasing prevalence of diabetes and comorbidity, counseling of diabetic patients is critical.
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Affiliation(s)
- Promise M Emeka
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Hofuf, Al Ahsa, Saudi Arabia
| | - Manea Fares AlMunjem
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Hofuf, Al Ahsa, Saudi Arabia
| | - Sahibzada Tasleem Rasool
- Department of Biomedical Sciences College of Clinical Pharmacy, King Faisal University, Hofuf, Al Ahsa, Saudi Arabia
| | - Noor Kamil
- Department of Pharmacology, Barrett Hodgson University, Karachi, Pakistan
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Pharmacist-led interventional programs for diabetic patients in Arab countries: A systematic review study. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00720-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Alqudah S, Jarab AS, Alefishat EA, Mayyas F, Khdour M, Pinto S. Factors Associated with Poor Hemoglobin A1c Control in Patients with Type 2 Diabetes. Curr Diabetes Rev 2019; 15:164-170. [PMID: 29745337 DOI: 10.2174/1573399814666180510144858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/18/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The limited implementation of clinical pharmacy service programs and the lack of studies identifying barriers to achieve blood glucose control have all attributed to the increased proportion of type 2 diabetes patients who have poor glycemic control in Jordan. OBJECTIVE To explore factors associated with higher HbA1c in patients with type 2 diabetes in Jordan. METHODS Variables including socio-demographics, disease and treatment factors were collected from171 patients with type2 diabetes at an outpatient diabetes clinic in Amman. Validated questionnaires were used to assess medication adherence, self-care activities, diabetes knowledge and healthrelated quality of life in addition to data collected from medical records. After the single-predictor analysis, stepwise linear regression was performed to develop a model with variables that best predicted hemoglobin A1c. RESULTS Medication adherence was inversely associated with HbA1c values (β = -0.275; t = 2.666; P < 0.01), indicating better glycemic control. Receiving insulin therapy was also associated with less HbA1c values and better glycemic control (β = - 0.184; t = 2.080; P < 0.05). Patients who had one or more comorbid conditions (β = 0.215; t = 2.264; P < 0.05) and those with longer diabetes duration (β = 0.092; t = 1.339; P < 0.05) were found to have significantly higher HbA1c values. CONCLUSION Emphasizing medication adherence, particularly for patients with longer duration of diabetes and those with multiple comorbid diseases should be strongly considered in future diabetes management programs implemented to improve glycemic control in patients with type 2 diabetes.
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Affiliation(s)
- Salam Alqudah
- Jordanian Royal Medical Services, Amman 11855, Jordan
| | - Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Eman A Alefishat
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman 11942, Jordan
| | - Fadia Mayyas
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Maher Khdour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Quds University, West Bank, Palestinian Territory, Occupied
| | - Sharrel Pinto
- Department of Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, The University of Toledo, Toledo, OH 43606, United States
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Curington R, Espel M, Heaton PC, Luder H, Brown B. Clinical outcomes of switching from insulin glargine to NPH insulin in indigent patients at a charitable pharmacy: The Charitable Insulin NPH: Care for the Indigent study. J Am Pharm Assoc (2003) 2017; 57:S229-S235. [PMID: 28366602 DOI: 10.1016/j.japh.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/27/2017] [Accepted: 02/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess the clinical outcomes of indigent patients with type 2 diabetes served by a charitable pharmacy after therapy change from insulin glargine to NPH insulin. DESIGN This was a 24-week prospective pilot study. SETTING Community charitable pharmacy. PARTICIPANTS Underserved, financially disadvantaged adults with type 2 diabetes. INTERVENTION Conversion from insulin glargine to NPH insulin. MAIN OUTCOME MEASURES HbA1c, 30-day average blood glucose, number of suspected and confirmed hypoglycemic episodes, total insulin dose, and Morisky Medication Adherence Scale (MMAS) scores. RESULTS Patients in both control and intervention groups improved in disease-state clinical markers, safety profile, and total insulin dose. MMAS scores were unchanged. CONCLUSION There were no statistically significant differences in glycemic control or hypoglycemic episodes between the control (NPH insulin) or intervention group (insulin glargine to NPH insulin).
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Doggrell SA, Chan V. Adherence to insulin treatment in diabetes: can it be improved? J Diabetes 2015; 7:315-21. [PMID: 25195971 DOI: 10.1111/1753-0407.12212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 08/20/2014] [Accepted: 08/24/2014] [Indexed: 01/26/2023] Open
Abstract
Insulin is used in all subjects with Type 1 diabetes, and when Type 2 diabetes is not controlled by oral anti-diabetic medicines, insulin is also used in Type 2 diabetes. However, despite this use, there is still increased mortality and morbidity in subjects with diabetes, compared to subjects without diabetes. One of the factors, which may be involved in this increased mortality and morbidity in subjects with diabetes, is nonadherence to insulin. Nonadherence rates to insulin are in the range of 20-38%, and many factors contribute to the nonadherence. The major aim of the review was to determine whether interventions to improve adherence to insulin do actually improve adherence to insulin. Most studies have shown that adherence to insulin was improved by changing from the vial-and-syringe approach to prefilled insulin pens, but not all studies have shown that this translated into better glycemic control and clinical outcomes. The results of studies using automatic telephone messages to improve adherence to insulin to date are inconclusive. There is limited and variable evidence that an intervention by a nurse/educator, which discusses adherence to medicines, does improve adherence to insulin. In contrast, there is little or no evidence that an extra intervention by a doctor or an intervention by a pharmacist, which discusses adherence to insulin, does actually improve the measured adherence to insulin. In conclusion, rather than assuming that an intervention by a health professional discussing adherence to insulin actually improves adherence to insulin, long-term studies investigating this are required.
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Affiliation(s)
- Sheila Anne Doggrell
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Doggrell SA, Chan V. Do interventions by allied health professionals discussing adherence to insulin improve this adherence? Diabetes Res Clin Pract 2014; 104:e61-3. [PMID: 24768512 DOI: 10.1016/j.diabres.2014.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 03/07/2014] [Accepted: 03/22/2014] [Indexed: 11/29/2022]
Abstract
It is assumed that interventions to improve the adherence to insulin by allied health professionals discussing adherence to insulin will improve this adherence. However, there is little evidence to support this, as interventions by a pharmacist or nurse educator have not been shown conclusively to improve adherence to insulin.
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Affiliation(s)
- S A Doggrell
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Gardens Point, GPO 2434, Brisbane, QLD 4001, Australia.
| | - V Chan
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Gardens Point, GPO 2434, Brisbane, QLD 4001, Australia
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Sullivan SD, Dalal MR, Burke JP. The impact of diabetes counseling and education: clinical and cost outcomes from a large population of US managed care patients with type 2 diabetes. DIABETES EDUCATOR 2013; 39:523-31. [PMID: 23640302 DOI: 10.1177/0145721713486525] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study is to examine outcomes in adult patients with type 2 diabetes mellitus who received diabetes counseling and education (C/E) services compared with those who did not. METHODS A matched, retrospective cohort study of 17 483 C/E recipients and 17 470 non-C/E controls was followed for up to 12 months. Outcomes included glycemic control (glycosylated hemoglobin A1C levels <7.0%), hypoglycemic events, and health care utilization and costs. RESULTS Compared with the non-C/E group, patients in the C/E group had significantly lower A1C (7.7% vs 7.2%) and were more likely to achieve glycemic control at 6 months' follow-up; they were also more likely to have a hypoglycemic event. During the 1-year period following the index date, C/E recipients had more inpatient visits (0.21 vs 0.20 visits per patient) and ambulatory visits (21.5 vs 18.6 visits per patient) compared with non-C/E controls. The increased use of health care services in the C/E groups was associated with $2388 higher annual overall costs and $827 higher diabetes-related costs. CONCLUSIONS Diabetes C/E is associated with improved glycemic control, albeit with a slight increase in the risk of hypoglycemia. C/E was associated with higher health care costs across 12 months. Further analyses are needed to evaluate long-term cost-effectiveness of diabetes counseling and education.
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Liday C. Overview of the guidelines and evidence for the pharmacologic management of type 2 diabetes mellitus. Pharmacotherapy 2012; 31:37S-43S. [PMID: 22122221 DOI: 10.1592/phco.31.12.37s] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The number of novel treatment options for type 2 diabetes mellitus, including those with distinctive mechanisms of action, has risen sharply this decade, and health care providers must be aware of the drugs' safety and efficacy in order to provide patients with the best care possible. Guidelines for type 2 diabetes provide recommendations for initiating and continuing treatment that will enable patients to achieve glycemic control and maintain it over time. Several recently completed, large clinical trials have provided information pertaining to potential benefits and risks of achieving specific treatment goals, and medical professionals should consider applying the insights from these trials when optimizing care for their patients. The pharmacist plays an essential role in helping patients achieve and maintain tight glycemic control by assisting other health care providers in understanding and utilizing the guidelines as part of individualized treatment regimens.
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Affiliation(s)
- Cara Liday
- Idaho State University College of Pharmacy, Pocatello, Idaho 83209-8333, USA
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Abstract
Treatment for patients with type 2 diabetes mellitus is typically initiated with a combination of lifestyle modification and oral drugs. This treatment provides sustained glycemic control in some patients, but many others require administration of insulin as their disease progresses and pancreatic β cells are lost. One of the most important points in long-term care for patients with type 2 diabetes is the transition to insulin therapy. Health care professionals must choose the most appropriate insulin preparations for management of patients with type 2 diabetes who cannot achieve treatment goals by using other therapies. These include basal, premixed, and basal-bolus insulin regimens. In addition, there are multiple approaches to initiation of insulin treatment, including addition of basal insulin to oral drugs, switching patients to a premixed insulin formulation, or basal-bolus treatment. The pharmacist can play a key role in the transition to insulin therapy by providing education and assisting in day-to-day management of patients with type 2 diabetes who require insulin for intensification of treatment.
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Affiliation(s)
- Kyle R Peters
- Siouxland Community Health Center, Sioux City, Iowa 51102, USA.
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Rochester CD, Leon N, Dombrowski R, Haines ST. Collaborative drug therapy management for initiating and adjusting insulin therapy in patients with type 2 diabetes mellitus. Am J Health Syst Pharm 2010; 67:42-8. [PMID: 20044368 DOI: 10.2146/ajhp080706] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Collaborative drug therapy management (CDTM) by pharmacists for initiating and adjusting insulin therapy in patients with type 2 diabetes mellitus in a Veterans Affairs Health Care System (VAHCS) is described. SUMMARY During 2003-04, the Veterans Affairs Maryland Health Care System (VAMHCS) at Baltimore reported that 24% of its patients with diabetes had a glycosylated hemoglobin (HbA(1c)) value of >9% or no recently documented HbA(1c) and that 91% of its patients with an HbA(1c) value of >9% were treated with oral antihyperglycemic agents alone. To address this issue, clinical pharmacists at VAMHCS at Baltimore developed the insulin initiation clinic. The primary goal of VAMHCS at Baltimore insulin initiation clinic was to provide an appropriate infrastructure to address the needs of patients with poorly controlled type 2 diabetes who required insulin therapy. Patients could be referred to the clinic if they had an HbA(1c) value of >9% on two occasions at least three months apart and were taking two oral antidiabetic medications whose dose was at least 50% of the maximal dose. The participating pharmacists mutually agreed to follow an insulin dosing protocol to help guide their therapeutic decision-making. Patients received comprehensive education during the initial visit regarding self-management skills, self-monitoring of blood glucose levels, treatment of hypoglycemia, insulin injection administration, and lifestyle modifications. Patients were discharged to their primary care provider if they attained an HbA(1c) value of <7.5% or after six months, whichever came first, during January 2005 and July 2008. CONCLUSION Use of a preplanned insulin initiation and titration protocol by pharmacists resulted in the successful implementation of an insulin initiation clinic through CDTM and improved patients' glycemic control.
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Affiliation(s)
- Charmaine D Rochester
- Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Room 449, 20 North Pine Street, Baltimore, MD 21201, USA.
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