Original Research
Safe and effective use of medicines for patients with type 2 diabetes – A randomized controlled trial of two interventions delivered by local pharmacies

https://doi.org/10.1016/j.sapharm.2014.03.003Get rights and content

Abstract

Background

Poor management of chronic medical treatments may result in severe health consequences for patients as well as costs for society. Non-adherence is common among patients with type 2 diabetes. Interventions by community pharmacists may assist in improving adherence and consequently health outcomes for patients with type 2 diabetes.

Objectives

The study aimed to investigate whether a comprehensive and a brief individually targeted intervention for patients with type 2 diabetes could improve implementation of drug therapy in Danish community pharmacies. The interventions intended to give patients more competence and support to improve adherence and self-management in order to reach treatment goals for diabetes and blood pressure as well as goals for patient perceived outcomes.

Methods

This study was an RCT, comparing two interventions; basic intervention (BI) and extended intervention (EI). The intervention model sought to identify drug-related problems as well as issues experienced by patients in relation to medicines use, and consequently find individually tailored solutions to address the identified problems.

Results

The trial included five pharmacies; five pharmacists and five pharmaconomists, and 205 patients; BI (39 patients), EI (41 patients), Control (125 patients). Patient reported systolic blood pressure improved in both groups and significantly in the EI group compared to the control group (P = 0.020). Increase in disease-related knowledge was higher in the EI group compared to the control group (P = 0.006), but not in the BI group (P = 0.139). Except for quality of life, the EI group reported significantly higher improvement in all aspects of beneficial effects from participating in the trial when compared to the control group. No significant differences were detected for changes in hospital admissions or in doctor visits. The two intervention groups reported significantly higher satisfaction with all aspects of patient satisfaction with pharmacy staff in the project than control patients.

Conclusions

The study showed improvement in patient health, well-being, knowledge, and satisfaction as a result of the trial, particularly for the EI group. Thus a program comprising patient narratives, problem and resource identification, and multi-dimensional individually tailored patient medication management solutions seems to be an appropriate intervention to ensure outcome improvement of non-adherent patients.

Section snippets

Background

Type 2 diabetes is one of the most prevalent chronic diseases affecting 350 million patients worldwide in 2011.1 In Denmark, 5.7% of the population – 320,545 persons – were diagnosed with diabetes in 2012.2 In 2005, a health technology assessment estimated that 100,000–150,000 were type 2 diabetes patients, but the real number of cases was estimated to be considerably higher (200,000–300,000) with 10,000–20,000 new cases each year.3 202,600 patients had a medicine against type 2 diabetes

Objectives

The aim of the study was to investigate whether a comprehensive and a brief individually targeted intervention for patients with type 2 diabetes could improve implementation of drug therapy in Danish community pharmacies. The intervention intended to give patients more competence and support to improve adherence and self-management in order to reach treatment goals for diabetes and blood pressure as well as goals for patient-perceived outcomes.

Methods

This study was designed as an RCT and included a comprehensive process evaluation. The RCT aimed to test two interventions for improving implementation of drug therapy in community pharmacies in the county of Funen in Denmark. In 2006, Funen had a mixed rural and urban population of 478,347 inhabitants, or approximately 9% of the Danish population.29

Results

Five pharmacies were included in the trial; five pharmacists and five pharmaconomists, and 205 patients met the inclusion criteria and were randomly allocated into three groups; 39 to the basic intervention (BI) group, 41 to the extended intervention (EI) group, and 125 to the control (C) group (Fig. 2). The patients were on average 62.6 years of age, 61.0% were males, and they were on average taking 4.7 drugs. No statistically significant differences in demographic or outcome variables were

Discussion

The study showed improvement in outcomes of patient health, well-being, knowledge and satisfaction as a result of the interventions – in particular for the EI group patients. Pharmacy staff reported satisfaction with their delivery of the intervention, but wished more involvement from the patients' GPs. Thus, a program comprising patient narratives, problem and resource identification, and multi-dimensional individually tailored patient medication management solutions seems to be an appropriate

Conclusion

The study showed improvement in patient health, well-being, knowledge, and satisfaction as a result of the interventions. This was in particular evident for patients in the EI group. Pharmacy staff reported satisfaction with their delivery of the interventions, but would have liked further involvement from the patients' GPs.

Thus a program comprising patient narratives, problem and resource identification, and multi-dimensional individually tailored patient medication management solutions seems

Acknowledgments

The project was supported financially by the Danish Health and Medicines Authority, Pharmadanmark, the Danish Association of Pharmaconomists, the Association of Danish Pharmacies and Pharmakon, and the Danish College of Pharmacy Practice.

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