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Pharmacy World and Science

, Volume 28, Issue 2, pp 65–72 | Cite as

A Pharmacotherapy Follow-Up Program in Patients with Type-2 Diabetes in Community Pharmacies in Spain

  • José A. Fornos
  • N. Floro AndrésEmail author
  • J. Carlos Andrés
  • M. Mercedes Guerra
  • Beatriz Egea
Research Article

Abstract

Objective

Poor metabolic control and high associated morbidity and mortality among type 2 diabetic patients require a level of care from the pharmacist that goes beyond usual dispensing. The aim of the present study was to evaluate the improvement in metabolic control, the resolution of drug-related problems (DRPs) and the increase in patient awareness of diabetes as outcomes of a pharmacotherapy follow-up program in type 2 diabetic patients.

Method

Randomized controlled trial conducted in 14 community pharmacies in the province of Pontevedra (Spain) with 112 patients between February 2003 and March 2004. The control group received the usual care, and the intervention group patients were included in a pharmacotherapy follow-up program. This individualized program, which consists of the detection and resolution of DRPs and diabetes education, involves patients in their own care in order to obtain maximum benefit from the medication they use.

Main outcome measures

HbA1c, Fasting Blood Glucose (FBG), lipid profile, blood pressure, body mass index (BMI), DRPs and knowledge were evaluated at the onset of the program and periodically until conclusion.

Results

There was a significant difference in changes from baseline between the intervention and the control group in DRPs (1.7±1.2 versus 3.1±1.2 P<0.0001), knowledge (17.9±3.7 versus 11.4±6.7 points P<0.0001), HbA1c (7.9±1.7 versus 8.5±1.9% P<0.0001), FBG (154±61.3 versus 168±57.8 mg/dl P=0.0004), total cholesterol (202±41.5 versus 217±43.5 mg/dl P=0.0054) and SBP (135±16.4 versus 150±19.9 mmHg P=0.0006).

Conclusions

A substantial number of patients showed an improvement in their outcomes for the chosen metabolic indicators. Pharmacotherapy follow-up programs conducted by community pharmacists can play an important role in achieving therapeutic goals in patients with type 2 diabetes.

This study shows that the incorporation of type 2 diabetic patients in a pharmacotherapy follow-up program may contribute to achieve positive clinical outcomes and will contribute to the implementation and progress of pharmacotherapy follow-up programs in community pharmacies.

Keywords

Pharmaceutical care Pharmacotherapy follow-up Diabetes knowledge Drug-related problems Community Pharmacy Type 2 diabetes Spain 

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Notes

Acknowledgements

The authors wish to thank all pharmacists and patients who participated in this study. We should also like to thank Bayer Spain, the Official College of Pharmacist of Pontevedra and the Pharmaceutical Northwest Wholesaler Cooperative (Cofano) for their financial support.

References

  1. 1.
    Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabet Care 2004; 27(5):2568–2569Google Scholar
  2. 2.
    Comité de Consenso. Segundo consenso de Granada sobre Problemas Relacionados con Medicamentos [Second Consensus of Granada on Drug Therapy Problems]. Ars Pharmaceutica 2002; 43:175–184Google Scholar
  3. 3.
    Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. Ann Pharmacother 1990; 24(11):1093–1097Google Scholar
  4. 4.
    Armando P, Semería N, Tenllado M, Sola N. Seguimiento farmacoterapéutico de pacientes en farmacias comunitarias [Pharmacotherapy follow-up of patients in community pharmacies]. Aten Primaria 2005; 36(3):129–136PubMedCrossRefGoogle Scholar
  5. 5.
    Gaede P, Vedel P, Larsen N, Jensen GV, Parvik HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348(5):383–393PubMedCrossRefGoogle Scholar
  6. 6.
    Grupo de Trabajo Diabetes Mellitus y Enfermedad Cardiovascular de la Sociedad Española de Diabetes. Diabetes mellitus y riesgo cardiovascular: Recomendaciones del Grupo de Trabajo Diabetes Mellitus y Enfermedad Cardiovascular de la Sociedad Española de Diabetes. [Diabetes mellitus and cardiovascular risk. Recommendations of Diabetes Mellitus and Cardiovascular Disease Working Group of the Spanish Society of Diabetes]. Clin Invest Arterioscl 2004; 16:74–78Google Scholar
  7. 7.
    Cioffi ST, Caron MF, Kalus JS, Hill P, Buckley TE. Glycosylated haemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic. Ann Pharmacother 2004; 38(5):771–775PubMedCrossRefGoogle Scholar
  8. 8.
    Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344(18):1343–1350PubMedCrossRefGoogle Scholar
  9. 9.
    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6):393–403PubMedCrossRefGoogle Scholar
  10. 10.
    Crutcher RA, Then K, Edwards A, Taylor K, Norton P. Multi-professional education in diabetes. Med Teach 2004; 26(5):435–443PubMedCrossRefGoogle Scholar
  11. 11.
    Sarkadi A, Rosenqvist U. Experience-based group education in type 2 diabetes: a randomized controlled trial. Patient Educ Couns 2004; 53(3):291–298PubMedCrossRefGoogle Scholar
  12. 12.
    Consensus Committee. Consensus on pharmaceutical care. Ars Pharmaceutica 2002; 42:221–241Google Scholar
  13. 13.
    Martin-Calero MJ, Machuca M, Murillo MD, Cansino J, Gastelurrutia MA, Faus MJ. Structural process and implementation programs of pharmaceutical care in different countries. Curr Pharm Des 2004; 10(31):3969–3985PubMedCrossRefGoogle Scholar
  14. 14.
    Cano-Pérez JF, Franch J, Mata M, miembros del Gedap S. Guía de tratamiento de la diabetes tipo 2 en Atención Primaria [Management guideline of type-2 diabetes in primary Care]. Madrid: Elsevier; 2004, ISBN 84-8174-823-4Google Scholar
  15. 15.
    American Diabetes Association. Standards of medical care in diabetes. Diabet Care 2005; 28(Suppl. 1):4–36Google Scholar
  16. 16.
    Machuca M, Fernandez-Llimos F, Faus MJ. Método Dáder. Guia de Seguimiento Farmacoterapéutico [The Dader method. Pharmacotherapy follow-up guideline]. Granada: Universidad de Granada; 2003, ISBN 84-600-9866-4Google Scholar
  17. 17.
    Fornos JA, Andrés NF, Guerra MM. Diseño y validación de un cuestionario de conocimiento sobre diabetes en pacientes de farmacia comunitaria [Design and validation of a knowledge questionnaire regarding diabetes among patients attending community pharmacy]. Pharm Care Esp 2003; 5(6):268–274Google Scholar
  18. 18.
    Peña F, Juárez J, Román J, Justo I. Resultados del Proyecto Triana. Seguimiento farmacoterapéutico en el paciente diabético de la provincia de Sevilla [Results of Triana Project. Pharmacotherapy follow-up on diabetic patients in the province of Seville]. Pharm Care Esp 2001; 3(Extra):62Google Scholar
  19. 19.
    Pérez T, González R, Rius C, Martín MJ. Incidencia del seguimiento farmacoterapéutico en pacientes diabéticos [Significance of pharmacotherapy follow-up on diabetic patients]. Seguim Farmacoter 2004; 2(4):228–234Google Scholar
  20. 20.
    Clifford RM, Davis WA, Batty KT, Davis TM. Effect of a pharmaceutical care program on vascular risk factors in type 2 diabetes: the Fremantle Diabetes Study. Diabet Care 2005; 28(4):771–776Google Scholar
  21. 21.
    Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321(7258):405–412PubMedCrossRefGoogle Scholar
  22. 22.
    Davidson MB, Karlan VJ, Hair TL. Effect of a pharmacist-managed diabetes care program in a free medical clinic. Am J Med Qual 2000; 15(4):137–142PubMedGoogle Scholar
  23. 23.
    Rothman R, Malone R, Bryant B, Horlen C, Pignone M. Pharmacist-led, primary care-based disease management improves haemoglobin A1c in high-risk patients with diabetes. Am J Med Qual 2003; 18(2):51–58PubMedGoogle Scholar
  24. 24.
    Choe HM, Mitrovich S, Dubay D, Hayward RA, Krein SL, Vijan S. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial. Am J Manag Care 2005; 11(4):253–260PubMedGoogle Scholar
  25. 25.
    Wermeille J, Bennie M, Brown I, McKnight J. Pharmaceutical care model for patients with type 2 diabetes: integration of the community pharmacist into the diabetes team-pilot study. Pharm World Sci 2004; 26(1):18–25PubMedCrossRefGoogle Scholar
  26. 26.
    Gill GV, Woodward A, Pradhan S, Wallymahmed M, Groves T, English P et al. Intensified treatment of type 2 diabetes, positive effects on blood pressure, but not glycaemic control. Q J Med 2003; 96(11):833–836Google Scholar
  27. 27.
    Simpson SH, Johnson JA, Biggs RS, Tsuyuki RT. Greater effect of enhanced pharmacist care on cholesterol management in patients with diabetes mellitus: a planned subgroup analysis of the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Pharmacotherapy 2004; 24(3):389–940PubMedCrossRefGoogle Scholar
  28. 28.
    Pedersen O, Gaede P. Intensified multifactorial intervention and cardiovascular outcomes in type 2 diabetes: the Steno-2 study. Metabolism 2003; 52(Suppl. 1):19–23PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • José A. Fornos
    • 1
  • N. Floro Andrés
    • 2
    • 4
    Email author
  • J. Carlos Andrés
    • 2
  • M. Mercedes Guerra
    • 3
  • Beatriz Egea
    • 2
  1. 1.Community pharmacist at CangasPontevedraSpain
  2. 2.Community pharmacist at VigoPontevedraSpain
  3. 3.Primary Care Service at A Guarda-RosalPontevedraSpain
  4. 4.Community pharmacist at VigoPontevedraSpain

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