Outcomes of a novel pharmacy screening intervention to address the burden of type 2 diabetes and cardiovascular disease in an Arabic-speaking country

Unmet healthcare needs of people with multimorbidity-can community pharmacists close the gap?

OBJECTIVES

Identify factors associated with unmet healthcare needs in patients with multimorbidity and determine the support community pharmacists can offer to meet these needs.

METHODS

People with multimorbidity were recruited from community pharmacies where research assistants approached all patients and asked them questions to determine their eligibility: having two or more chronic conditions, being at least 18 years old, and speaking either Arabic or English. Those who met the criteria were invited to participate in the study. Consenting participants completed a survey designed based on international guidelines, utilizing validated tools to measure healthcare needs, quality of life, treatment burden, and medication self-efficacy. Generalized linear models were used to identify predictors of unmet needs.

KEY FINDINGS

Two hundred and twenty-four participants completed the survey (response rate = 81%). Participants indicated significant healthcare needs particularly in areas such as communication and relationships (M = 4.4 ± 0.9) and medication information (M = 3.8 ± 0.7). Higher education and medication self-efficacy were associated with lower needs for counselling (B = -0.966; P < .001 and B = -113; P < .001, respectively) and communication (B = -0.547; P < .008 and B = -0.088; P = .003, respectively).

CONCLUSIONS

This study demonstrated community pharmacists' potential to address multimorbidity. To optimize their role, primary healthcare delivery needs to be reorganized to empower pharmacists to support patients with complex healthcare needs.

Point-of-Care testing of HbA1c levels in community settings for people with established diabetes or people at risk of developing diabetes: A systematic review and meta-analysis

BACKGROUND

Glycated haemoglobin (HbA1c) measurement using Point of Care (POC) testing may be of huge utility, providing convenient testing for early diagnosis and regular monitoring of hard-to-reach patient groups. This systematic review aimed to identify evidence for the successful deployment of these devices to improve patient outcomes in diabetes.

METHODS

A systematic review and meta-analysis was undertaken in February 2023, to identify all relevant articles: (CINAHL, Cochrane, PubMed, Scopus, and Web of Science). Studies were included if they reported outcomes of community POC testing for HbA1c for people with diabetes or at risk of diabetes. The Prospero database and trial registers were searched. Only English language articles were included. Title, abstract screening and full text review was carried out by two reviewers (AG/AR). The Cochrane risk of bias tool for randomised studies and the NIH Quality Assessment tool for observational cohort and cross-sectional studies were used. Publication bias was assessed visually using funnel plot and statistical assessment. We performed a meta-analysis on appropriate studies, applying a fixed effect model. We investigated heterogeneity using visual inspection of forest plots along with evaluative approaches (χ2, I2). Strength of evidence was assessed using GRADE.

FINDINGS

24 studies fulfilled the criteria to be included in the narrative synthesis and 5 could be included in quantitative analysis. 13 studies evaluated HbA1c POC testing in non-diabetic patients, 9 reported results for diabetic patients and 2 included both groups. The narrative synthesis was constructed around 6 key themes: increased test access, diagnosis of people who would otherwise go undiagnosed, intervention/lifestyle change, POC testing effect on HbA1c and glycaemic control, follow-up time and patient satisfaction.

INTERPRETATION

The available published data supports the proposed use of POC devices in a community setting, with positive effects on diabetic care with limited evidence that patients can achieve better glycaemic control.