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International Journal of Clinical Pharmacy

, Volume 40, Issue 2, pp 354–359 | Cite as

The influence of pharmacist-led adherence support on glycaemic control in people with type 2 diabetes

  • Mangesh KharjulEmail author
  • Rhiannon Braund
  • James Green
Research Article

Abstract

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.

Keywords

Adherence Diabetes mellitus HbA1c Hypoglycaemic medications New Zealand Pharmacist 

Notes

Acknowledgements

We would like to thank the MUR coordinator and the community pharmacists who participated in this study and helped us with the data collections.

Funding

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.

References

  1. 1.
    Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304–14.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 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.
  3. 3.
    Ganguli A, Clewell J, Shillingto AC. The impact of patient support programs on adherence, clinical, humanistic, and economic patient outcomes: a targeted systematic review. Patient Prefer Adherence. 2016;10:711–25.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Tan EC, Stewart K, Elliott RA, George J. Pharmacist services provided in general practice clinics: a systematic review and meta-analysis. Res Social Adm Pharm. 2014;10(4):608–22.CrossRefPubMedGoogle Scholar
  5. 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. 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. 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. 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. 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. 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. 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
  12. 12.
    Hatah E, Braund R, Tordoff J, Duffull SB. A systematic review and meta-analysis of pharmacist-led fee-for-services medication review. Br J Clin Pharmacol. 2014;77(1):102–15.CrossRefPubMedGoogle Scholar
  13. 13.
    Hugtenburg JG, Timmers L, Elders PJ, Vervloet M, van Dijk L. Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Person Prefer Adherence. 2013;10(7):675–82.CrossRefGoogle Scholar
  14. 14.
    Hertz RP, Unger AN, Lustik MB. Adherence with pharmacotherapy for type 2 diabetes: a retrospective cohort study of adults with employer-sponsored health insurance. Clin Ther. 2005;27(7):1064–73.CrossRefPubMedGoogle Scholar
  15. 15.
    Liebl A, Neiss A, Spannheimer A, Reitberger U, Wieseler B, Stammer H, et al. Complications, co-morbidity, and blood glucose control in type 2 diabetes mellitus people in Germany—results from the CODE-2 study. Exp Clin Endocrinol Diabetes. 2002;110:10–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Egede LE, Gebregziabher M, Dismuke CE, Lynch CP, Axon RN, Zhao Y, et al. Medication nonadherence in diabetes: longitudinal effects on costs and potential cost savings from improvement. Diabetes Care. 2012;35(12):2533–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Pladevall M, Williams LK, Potts LA, Divine G, Xi H, Lafata JE. Clinical outcomes and adherence to medications measured by claims data in people with diabetes. Diabetes Care. 2004;27(12):2800–5.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Balkrishnan R, Rajagopalan R, Camacho FT, Huston SA, Murray FT, Anderson RT. Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus: a longitudinal cohort study. Clin Ther. 2003;25(11):2958–71.CrossRefPubMedGoogle Scholar
  19. 19.
    Khaw KT. Elevated HbA1c level: a risk factor for cardiovascular disease mortality in people with chronic heart failure? Nat Clin Pract Endocrinol Metab. 2009;5(3):130–1.CrossRefPubMedGoogle Scholar
  20. 20.
    Chan WB, Tong PCY, Chow CC, So WY, Ng MCY, Ma RCW, et al. Triglyceride predicts cardiovascular mortality and its relationship with glycaemia and obesity in Chinese type 2 diabetic people. Diabetes Metab Res Rev. 2005;21(2):183–8.CrossRefPubMedGoogle Scholar
  21. 21.
    UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in people with type 2 diabetes (UKPDS 33. Lancet. 1998;352(9131):837–53.CrossRefGoogle Scholar
  22. 22.
    Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan DM, Peterson CM. Tests of glycemia in diabetes. Diabetes Care. 2004;27(1):S91–3.PubMedGoogle Scholar
  23. 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.
  24. 24.
    Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan DM, Peterson CM. Tests of glycemia in diabetes. Diabetes Care. 2004;27(7):1761–73.CrossRefPubMedGoogle Scholar
  25. 25.
    Braatvedt GD, Cundy T, Crooke M, Florkowski C, Mann JI, Lunt H, Jackson R, Orr-Walker B, Kenealy T, Drury PL. Understanding the new HbA1c units for the diagnosis of Type 2 diabetes. N Z Med J. 2012;125(1362):70–80.PubMedGoogle Scholar
  26. 26.
    Farsaei S, Sabzghabaee AM, Zargarzadeh AH, Amini M. Effect of pharmacist-led patient education on glycemic control of type 2 diabetics: a randomized controlled trial. J Res Med Sci. 2011;16(1):43–9.PubMedPubMedCentralGoogle Scholar
  27. 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
  28. 28.
    Butt M, Mhd Ali A, Bakry MM, Mustafa N. Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: a randomised controlled study. Saudi Pharm J. 2016;24(1):40–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Korcegez EI, Sancar M, Demirkan K. Effect of a pharmacist-led program on improving outcomes in patients with type 2 diabetes mellitus from Northern Cyprus: a randomized controlled trial. J Manag Care Spec Pharm. 2017;23(5):573–82.CrossRefPubMedGoogle Scholar
  30. 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.
  31. 31.
    Hörnsten A, Stenlund H, Lundman B, Sandström H. Improvements in HbA1c remain after 5 years–a follow up of an educational intervention focusing on patients’ personal understandings of type 2 diabetes. Diabetes Res Clin Pract. 2008;81(1):50–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Tien KJ, Hung HC, Hsiao JY, Hsu SC, Hsin SC, Shin SJ, et al. Effectiveness of comprehensive diabetes care program in Taiwanese with type 2 diabetes. Diabetes Res Clin Pract. 2008;79(2):276–83.CrossRefPubMedGoogle Scholar
  33. 33.
    Welch G, Garb J, Zagarins S, Lendel I, Gabbay RA. Nurse diabetes case management interventions and blood glucose control: results of a meta-analysis. Diabetes Res Clin Pract. 2010;88(1):1–6.CrossRefPubMedGoogle Scholar
  34. 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.
  35. 35.
    Harrop A. The value of laboratory values: a community pharmacy perspective. Can Pharm J CPJ. 2015;148(3):115–7.CrossRefGoogle Scholar
  36. 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
  37. 37.
    Leung WY, So WY, Tong PC, Chan NN, Chan JC. Effects of structured care by a pharmacist-diabetes specialist team in patients with type 2 diabetic nephropathy. Am J Med. 2005;118(12):1414.CrossRefPubMedGoogle Scholar
  38. 38.
    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):253–60.PubMedGoogle Scholar
  39. 39.
    ISMP. Adjust Pradaxa dose for renal impairment. 2011. www.ismp.org/newsletters/ambulatory/archives/2011102_1.asp. Accessed 2 Nov 2017.
  40. 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.
  41. 41.
    Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith SM. Managing patients with multimorbidity in primary care. BMJ. 2015;20(350):h176.CrossRefGoogle Scholar
  42. 42.
    Shawn McFarland M, Wallace JP, Parra J, Baker J. Evaluation of patient satisfaction with diabetes management provided by clinical pharmacists in the patient-centered medical home. Patient. 2014;7(1):115–21.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of PharmacyUniversity of OtagoDunedinNew Zealand

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