Pharmaceutical care model for patients with type 2 diabetes: integration of the community pharmacist into the diabetes team – a pilot study
- 687 Downloads
Objective: To evaluate the feasibility and impact of a structured approach for community pharmacist input as a member of the multidisciplinary team caring for patients with type-2 diabetes and health professional providing advice on medication. Methods: Prospective pretest-posttest single group study. Sixty-two patients on oral hypoglycaemic therapy, identified as regular customers of four Scottish (UK) community pharmacies, were recruited. Each patient underwent an initial assessment: review of medical general practice notes/community pharmacy PMR (Patient medication record) system and structured interview. Standardised documentation was completed, a pharmaceutical care plan (PCP) prepared, peer-reviewed and then discussed face-to-face with patients' GPs (general practitioners). A second (final) assessment was conducted 24 to 28 weeks from the initial interview.
Main outcome measures: Pharmaceutical care issues (PCIs) throughout study period; change in parameters from initial to final assessment: patient knowledge of oral hypoglycaemic and anti-hypertensive therapy; HbA1c; blood pressure; total cholesterol; medication compliance.
Results: A total of 178 PCIs were identified (mean [range] 2.9 [1–5] per patient) and categorised: drug therapy problems (n=76); monitoring (n=21); and patient knowledge (n=81). Drug therapy problems discussed with the GPs were agreed for 74 (97%) and resolved for 55 (72%) at final assessment. Biological outcome measures were assessed for 59 patients (3 drop-outs). A reduction (P < 0.05) in HbA1c, blood pressure and total cholesterol was observed over the study period. Patients knowledge was poor for oral hypoglycaemic therapy but improved (initial-51%, final-72%, P < 0.05).
Conclusion: This study demonstrated a feasible pharmaceutical care model for diabetes patients in an European country. The results have shown the pharmacist to be effective and well accepted by GPs and patients.
Unable to display preview. Download preview PDF.
- 1.Diabetes care and research in Europe: The Saint Vincent declaration. Diabet Med 1990; 7: 360.Google Scholar
- 2.Diabetes UK. Counting the cost: the real impact of non-insulin dependent diabetes, Kings Fund Policy Institute report commissioned by Diabetes UK, London, 1996.Google Scholar
- 3.Bennett N, Dodd T, Flately J, Freeth S, Bolling K. Health survey for England 1993. Social Survey Division of the Office of Population Censuses and Surveys, London: HMSO 1995.Google Scholar
- 4.The Diabetes Control and Complication Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long term complication in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86.Google Scholar
- 5.UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complication in patients with type 2 diabetes: UKPDS 33. Lancet 1998; 352: 837–53.Google Scholar
- 6.UK Prospective Diabetes Study Group. Effect of intensive blood glucose control with metformin on complication in overweight patients with type 2 diabetes: UKPDS 34. Lancet 1998; 352: 854–65.Google Scholar
- 7.UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complication in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–13.Google Scholar
- 8.UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complication in type 2 diabetes: UKPDS 39. BMJ 1998; 317: 713–20.Google Scholar
- 9.Keen H, Hall M. Saint Vincent: A new responsibility for general practitioners? Br J Gen Pract 1996: 447–8.Google Scholar
- 10.Diabetes Task Force. Guidelines for Community Pharmacists on the care of patients with Diabetes. London: Royal Pharmaceutical Society of Great Britain, 2001.Google Scholar
- 11.NHS Scotland. Our National Health: A Plan for Action, a Plan for Change. Edinburgh: Scottish Executive, 2000.Google Scholar
- 12.Scottish Office Department of Clinical Resource and Audit Group. Clinical Pharmacy Practice in Primary Care. Edinburgh: Scottish Office Department of Health, 1999.Google Scholar
- 13.Ramsay LE, Williams B, Johnston GD, MacGregor GA, Poston L, Potter JF etal. Guidelines for management of hypertension: report of the third working party of the British Hypertension Society. J Hum Hypertens 1999; 13: 569–92.Google Scholar
- 14.Cipolle RJ, Strand LM, Morley PC. Identifying, resolving, and preventing drug therapy problems: the pharmacist's responsibility. In: Pharmaceutical Care Practice. 1st ed. New York: Mc-Graw-Hill, 1998.Google Scholar
- 15.Cockroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.Google Scholar
- 16.Morris LS, Schulz R. Patient compliance — an overview. J Clin Pharm Ther 1992; 17: 283–95.Google Scholar
- 17.Sarkadi A, Rosenqvist U. Field test of a group education program for type 2 diabetes: Measures and predicators of success on individual and group levels. Patient Educ Couns 2001; 44: 129–39.Google Scholar
- 18.Royal Pharmaceutical Society of Great Britain. From compliance to concordance — achieving partnership in medicine-taking. London: RPSGB, 1997.Google Scholar
- 19.Department of Health. National Framework for older people: Medicines and older people — implementing medicines-related aspects of the NSF for older people. London: Dept of Health, 2001.Google Scholar
- 20.Rendell M, Lassek WD, Ross DA, Smith C, Kernek S, Williams J et al. A pharmaceutical profile of diabetic patients. J Chron Dis 1983; 36: 193–202.Google Scholar
- 21.Douglas E, Bennie M, McAnaw J, Hudson S. Diabetes mellitus. Pharm J 1998; 261: 810–8.Google Scholar
- 22.Colley C, Lucas L. Polypharmacy: the cure becomes the disease. J Gen Intern Med 1993; 8: 278–83.Google Scholar
- 23.Paes AHP, Bakker A, Soe-Agnie CJ. Impact of dosage frequency on patient compliance. Diabetes Care 1997; 20: 1512–7.Google Scholar
- 24.Van Veldhuizen-Scott MK, Widmer LB, Stacey SA, Popovich NG. Developing and implementing a pharmaceutical care model in an ambulatory care setting for patients with diabetes. Diabetes Educ 1995; 21: 117–23.Google Scholar
- 25.Jaber LA, Halapy H, Fernet M, Tummalapalli S, Diwakaran H. Evaluation of a pharmaceutical care model on diabetes management. Ann Pharmacother 1996; 30: 238–43.Google Scholar
- 26.Monaghan MJ, Monaghan MS. Are pharmacists and pharmaceutical care having an impact on diabetes? Pharm Pract Manage Q 1998; 17: 8–16.Google Scholar
- 27.Berringer R, Shibley MC, Cary CC, Pugh CB, Powers PA, Rafi JA. Outcomes of a community pharmacy-based diabetes monitoring program. J Am Pharm Ass 1999; 39: 791–7.Google Scholar