The influence of pharmacist-led adherence support on glycaemic control in people with type 2 diabetes
Background Adherence to treatment is important to achieve target outcomes, particularly for those with type 2 diabetes. Pharmacists are well placed to enhance adherence, however evidence of the impact on clinical outcomes is not well known. Objective To determine the impact of an adherence support service on adherence scores and subsequent clinical biomarkers (HbA1c). Setting Community pharmacies providing a Medicines Use Review (MUR) Service in a New Zealand locality. Methods Records of patients receiving MURs between 2007 and 2012 were obtained from a single locality. Data extraction included: individual characteristics, the adherence score assigned at every consultation, pathology records. Patients receiving oral hypoglycaemic medications (n = 86) were included in the final analysis using generalised estimating equations to explore change in HbA1c over time, and whether this was related to the adherence score. Main Outcome Measures (a) change in adherence scores and (b) association between adherence sores and HbA1c. Results A total of 350 records were obtained, of those, 115 of 350 people had follow up MUR visit/s and could be analysed for changes in adherence. Most people (110/115) showed sustained or improved adherence scores with follow up visits. For those receiving oral hypoglycaemic medications (n = 86); where poor adherence scores were recorded, their HbA1c levels were higher and continued to increase by ~ 0.1% (1 mmol/mol) every 10 weeks, B = 0.11, p = 0.009. Conversely, those with high adherence scores showed an overall decrease in HbA1c levels. Conclusion MURs may positively influence medication adherence. This improved adherence shows a measurable decline in HbA1c levels.
KeywordsAdherence Diabetes mellitus HbA1c Hypoglycaemic medications New Zealand Pharmacist
We would like to thank the MUR coordinator and the community pharmacists who participated in this study and helped us with the data collections.
Mangesh D. Kharjul was supported by a School of Pharmacy PhD stipend.
Conflicts of interest
The authors declare that they have no conflicts of interest.
- 2.Sabate E, editor. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization. 2003. http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf?ua=1. Accessed 02 Nov 2017.
- 5.Clyne W, Blenkinsopp A, Seal R. A guide to medication review. 2008. http://www.sefap.org/media/upload/arxius/formacion/aula_fap_2010/bibliografia/guide_medication_review_2008.pdf. Accessed 02 Nov 2017.
- 6.American Pharmacists Association and National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice: core elements of an MTM service model. 2008. http://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf. Accessed 02 Nov 2017.
- 7.Ontario Ministry of Health and Long-Term Care. MedsCheck. 2011. http://www.health.gov.on.ca/en/pro/programs/drugs/medscheck/medscheck_original.aspx. Accessed 02 Nov 2017.
- 8.Pharmaceutical Society of Australia Ltd. Guidelines for pharmacists providing Home Medicines Review (HMR) services. https://www.psa.org.au/download/practice-guidelines/home-medicines-review-services.pdf. Accessed 02 Nov 2017.
- 9.Pharmaceutical Society of New Zealand Inc. New Zealand National Pharmacist Services Framework. 2014. https://www.psnz.org.nz/Folder?Action=View%20File&Folder_id=86&File=PSNZPharmacistServicesFramework2014FINAL.pdf. Accessed 02 Nov 2017.
- 10.Lee E, Braund R, Tordoff J. Examining the first year of medicines use review services provided by pharmacists in New Zealand: 2008. N Z Med J. 2009;22(1293):26–35.Google Scholar
- 11.Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. J Public Health (Oxf). 2015;37(4):716–27.Google Scholar
- 23.New Zealand Society for the Study of Diabetes: NZSSD position statement on screening and type 2 diabetes. 2011. http://www.nzssd.org.nz/HbA1c/1.%20NZSSD%20position%20statement%20on%20screening%20for%20type%202%20diabetes%20final%20Sept%202011.pdf. Accessed 02 Nov 2017.
- 27.Ayadurai S, Hattingh HL, Tee LB, Md Said SN. A Narrative review of diabetes intervention studies to explore diabetes care opportunities for pharmacists. J Diabetes Res. 2016; Article Id 5897452:1–11.Google Scholar
- 30.Wang M. Generalized estimating equations in longitudinal data analysis: a review and recent developments. Adv Stat. 2014; 2014, Article ID 303728. https://doi.org/10.1155/2014/303728.
- 34.Sharing health information—the way of the future published by New Zealand Ministry of Health. http://www.health.govt.nz/system/files/documents/topic_sheets/sharing-health-information-flyer.pdf. Accessed 02 Nov 2017.
- 36.Gernant SA, Zillich AJ, Snyder ME. Access to medical records’ impact on community pharmacist-delivered medication therapy management: a pilot from the medication safety research network of Indiana (Rx-SafeNet). J Pharm Pract. 2017;1:897190017735422.Google Scholar
- 39.ISMP. Adjust Pradaxa dose for renal impairment. 2011. www.ismp.org/newsletters/ambulatory/archives/2011102_1.asp. Accessed 2 Nov 2017.
- 40.British Columbia Pharmacy Association (BCPhA) Clinical Service Proposal, Medication Adherence Services, Canada. 2013. http://studyres.com/doc/23992964/medication-adherence-services. Accessed 02 Nov 2017.