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Jairoun AA, Al-Hemyari SS, Shahwan M, Hassan N, Zyoud SH, Jaber AAS, Al-Qirim T. Insights Into Metformin XR Pharmacotherapy Knowledge Among Community Pharmacists: A Cross-Sectional Study. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231203913. [PMID: 37846366 PMCID: PMC10576939 DOI: 10.1177/11795514231203913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/02/2023] [Indexed: 10/18/2023] Open
Abstract
Background There is a little knowledge on the extent to which healthcare providers understand and accept the professional recommendations and appropriate dosing strategy regarding metformin XR. Objectives To evaluate UAE community pharmacists' knowledge, attitude, and practices (KAP) concerning metformin XR. Methods This is a cross-sectional research study conducted amongst licensed community pharmacists. The survey took place via a questionnaire and physical interviews were held. The survey used in this study included questions on demographics and questions on the participants' attitudes, knowledge and practices concerning metformin XR. The factors influencing KAP regarding metformin XR were examined via simple logistic regression analysis. Results Threehundred fifty-three (n = 353) participants were recruited in the study. Independent pharmacies constituted 57.5% of this study sample and 42.5% were chain pharmacies. The average knowledge score about metformin XR tablets was 42.5% with a confidence interval (CI) of 95% [37.3%, 47.4]. Better knowledge scores on metformin XR tablets was observed in respondents aged ⩾40 years (OR 2.97, 95% CI 1.63-5.4), having greater than 10 years in terms of experience (OR 2.28; 95% CI 1.25-4.16) and pharmacist graduated from Regional or international universities (OR 2.08; 95% CI 1.34-3.24). About 78% (n = 275) of the participants believed that metformin XR tablets have better efficacy and 63.2% (n = 233) indicated that metformin IR was associated with greater adverse effects. Conclusion This study demonstrated a distinct gap in knowledge, attitude and practice pertaining to metformin XR among community pharmacists in the UAE. The community pharmacists need to enhance their practice by receiving accurate and reliable data to support their decision-making on the prescribing of metformin XR. The implementation of novel guidelines and evidence dissemination strategies may help bridge this gap.
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Affiliation(s)
- Ammar Abdulrahman Jairoun
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, Malaysia
| | - Sabaa Saleh Al-Hemyari
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, Malaysia
- Pharmacy Department, Emirates Health Services, Dubai, United Arab Emirates
| | - Moyad Shahwan
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Nageeb Hassan
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Sa’ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Clinical Research Centre, An-Najah National University Hospital, Nablus, Palestine
| | - Ammar Ali Saleh Jaber
- Department of Clinical Pharmacy & Pharmacotherapeutics, Dubai Pharmacy College for Girls, Al mizhar Dubai, United Arab Emirates
| | - Tariq Al-Qirim
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
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Cahyaningsih I, Lambert M, Ochi T, Li F, Li X, Denig P, Taxis K. Community pharmacist-led interventions for patients with type 2 diabetes in low-income and middle-income countries: A scoping review. Res Social Adm Pharm 2023:S1551-7411(23)00238-3. [PMID: 37270326 DOI: 10.1016/j.sapharm.2023.04.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Studies assessing community pharmacist-led interventions conducted in high-income countries indicate that community pharmacists are successful in taking opportunities to support diabetes management. It is not yet clear as to what extent this is also true for low-income and middle-income countries. OBJECTIVES To provide an overview of the types of interventions performed by community pharmacists and available evidence about their effects on patients with type 2 diabetes mellitus in low-income and middle-income countries. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for (non) randomized controlled, before-and-after, and interrupted time series design studies. There was no restriction on publication language. Interventions to be included had to be delivered by community pharmacists in a primary care or community setting. Study quality was assessed using the National Institute of Health tools, with results analyzed qualitatively, and the review itself was conducted in accordance with guidelines for scoping reviews. RESULTS Twenty-eight studies were included, representing 4,434 patients (mean age from 47.4 to 59.5 years, 55.4% female) from community pharmacies (16 studies), primary care centers (8 studies) or community setting (4 studies). Four studies were single-component and the remaining represented multi-component interventions. Face-to-face counseling of patients was the most common intervention, often combined with the provision of printed materials, remote consultations, or conducting medication reviews. Generally, studies showed improved outcomes in the intervention group, including clinical, patient-reported and medication safety outcomes. In most studies, at least one domain was judged to be of poor quality, with heterogeneity among studies. CONCLUSIONS Community pharmacist-led interventions on type 2 diabetes mellitus patients showed various positive effects but the quality of the evidence was poor. Face-to-face counseling of varying intensity, often combined with other strategies and representing a multi-component intervention, was the most common type. Although these findings support the expansion of the community pharmacist's role in diabetes care in low-income and middle-income countries, better quality studies are needed to evaluate the impact of specific interventions.
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Affiliation(s)
- Indriastuti Cahyaningsih
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands; Department of Pharmacist Profession Education, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Brawijaya, Geblagan, Tamantirto, Bantul, Daerah Istimewa Yogyakarta, 55183, Indonesia.
| | - Maarten Lambert
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Taichi Ochi
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Fang Li
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Xinyu Li
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
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Hassan F, Hatah E, Ali AM, Wen CW. The intervention strategies and service model for pharmacist-led diabetes management: a scoping review. BMC Health Serv Res 2023; 23:46. [PMID: 36653832 PMCID: PMC9847048 DOI: 10.1186/s12913-022-08977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is increasing intervention activities provided during pharmacist-led diabetes management. Nevertheless, there is an unclear definition of the activities involved during the intervention. Thus, this study aimed to describe the type of intervention strategies and service model provided during pharmacist-led type 2 diabetes management and service outcomes. METHODS This study utilized the scoping review methodology of the Joanna Briggs Institute Reviewers' Manual 2015. Articles on pharmacist-led diabetes management focusing on the service content, delivery methods, settings, frequency of appointments, collaborative work with other healthcare providers, and reported outcomes were searched and identified from four electronic databases: Ovid Medline, PubMed, Scopus, and Web of Science from 1990 to October 2020. Relevant medical subject headings and keywords, such as "diabetes," "medication adherence," "blood glucose," "HbA1c," and "pharmacist," were used to identify published articles. RESULTS The systematic search retrieved 4,370 articles, of which 61 articles met the inclusion criteria. The types of intervention strategies and delivery methods were identified from the studies based on the description of activities reported in the articles and were tabulated in a summary table. CONCLUSION There were variations in the descriptions of intervention strategies, which could be classified into diabetes education, medication review, drug consultation/counseling, clinical intervention, lifestyle adjustment, self-care, peer support, and behavioral intervention. In addition, most studies used a combination of two or more intervention strategy categories when providing services, with no specific pattern between the service model and patient outcomes.
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Affiliation(s)
- Fahmi Hassan
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia ,grid.415759.b0000 0001 0690 5255Pharmacy Services Program, Ministry of Health Malaysia, Lot 36 Jalan Universiti, 46350 Petaling Jaya, Selangor Malaysia
| | - Ernieda Hatah
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Chong Wei Wen
- grid.412113.40000 0004 1937 1557Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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Malik M, Hussain A, Aslam U, Hashmi A, Vaismoradi M, Hayat K, Jamshed S. Effectiveness of Community Pharmacy Diabetes and Hypertension Care Program: An Unexplored Opportunity for Community Pharmacists in Pakistan. Front Pharmacol 2022; 13:710617. [PMID: 35656287 PMCID: PMC9152095 DOI: 10.3389/fphar.2022.710617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The effective management of patients diagnosed with both Diabetes as well as Hypertension is linked with administration of efficacious pharmacological therapy as well as improvement in adherence through counseling and other strategies. Being a part of primary healthcare team, community pharmacists can effectively provide patient care for chronic disease management. The objective of the study was to evaluate the impact of pharmacist counseling on blood pressure and blood glucose control among patients having both hypertension and diabetes attending community pharmacies in Pakistan. Method: A randomized, controlled, single-blind, pre-post-intervention study design was used. The respondents included patients diagnosed with diabetes mellitus (Type I or II) and hypertension visiting community pharmacies to purchase their regular medicine. A simple random sampling technique using the lottery method was used to select community pharmacies in groups A (intervention, n = 4) and group B (control, n = 4). The total number of patients was 40 in each group, while estimating a dropout rate of 25%. The patients in the intervention group received special counseling. Blood pressure and blood glucose were checked after every 15 days for 6 months. Prevalidated tools such as the hypertension knowledge level scale, the diabetes knowledge questionnaire 24, and a brief medication questionnaire was used. Data were coded and analyzed using SPSS 21. Wilcoxon test (p < 0.05) was used to compare pre-post intervention knowledge regarding the disease, while the Mann-Whitney test (p < 0.05) was used to find differences in medication adherence among control and intervention groups. Results: A significant improvement in mean knowledge scores of patients with diabetes (16.02 ±2.93 vs. 19.97 ±2.66) and hypertension (15.60 ±3.33 vs. 18.35 ±2.31) in the intervention group receiving counseling for 6 months than control group (p < 0.05) was noted. Furthermore, the fasting blood glucose levels (8.25 ±1.45) and systolic BP (130.10 ±6.89) were significantly controlled after 6 months in the intervention group. Conclusion: The current study results concluded that community pharmacists' counselling has a positive impact on blood glucose and blood pressure management among patients suffering with both diabetes and hypertension.
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Affiliation(s)
- Madeeha Malik
- Department of Pharmacy Practice, Hamdard Institute of Pharmaceutical Sciences, Hamdard University Islamabad, Islamabad, Pakistan
| | - Azhar Hussain
- Department of Pharmacy Practice, Hamdard Institute of Pharmaceutical Sciences, Hamdard University Islamabad, Islamabad, Pakistan
| | - Usman Aslam
- Department of Pharmacy Practice, Hamdard Institute of Pharmaceutical Sciences, Hamdard University Islamabad, Islamabad, Pakistan
| | - Ayisha Hashmi
- Department of Pharmacy Practice, Hamdard Institute of Pharmaceutical Sciences, Hamdard University Islamabad, Islamabad, Pakistan
| | | | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Terengganu, Malaysia.,Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
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Crutzen S, Belur Nagaraj S, Taxis K, Denig P. Identifying patients at increased risk of hypoglycaemia in primary care: Development of a machine learning-based screening tool. Diabetes Metab Res Rev 2021; 37:e3426. [PMID: 33289318 PMCID: PMC8518928 DOI: 10.1002/dmrr.3426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/05/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION In primary care, identifying patients with type 2 diabetes (T2D) who are at increased risk of hypoglycaemia is important for the prevention of hypoglycaemic events. We aimed to develop a screening tool based on machine learning to identify such patients using routinely available demographic and medication data. METHODS We used a cohort study design and the Groningen Initiative to ANalyse Type 2 diabetes Treatment (GIANTT) medical record database to develop models for hypoglycaemia risk. The first hypoglycaemic event in the observation period (2007-2013) was the outcome. Demographic and medication data were used as predictor variables to train machine learning models. The performance of the models was compared with a model using additional clinical data using fivefold cross validation with the area under the receiver operator characteristic curve (AUC) as a metric. RESULTS We included 13,876 T2D patients. The best performing model including only demographic and medication data was logistic regression with least absolute shrinkage and selection operator, with an AUC of 0.71. Ten variables were included (odds ratio): male gender (0.997), age (0.990), total drug count (1.012), glucose-lowering drug count (1.039), sulfonylurea use (1.62), insulin use (1.769), pre-mixed insulin use (1.109), insulin count (1.827), insulin duration (1.193), and antidepressant use (1.05). The proposed model obtained a similar performance to the model using additional clinical data. CONCLUSION Using demographic and medication data, a model for identifying patients at increased risk of hypoglycaemia was developed using machine learning. This model can be used as a tool in primary care to screen for patients with T2D who may need additional attention to prevent or reduce hypoglycaemic events.
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Affiliation(s)
- Stijn Crutzen
- Department of Clinical Pharmacy and PharmacologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Sunil Belur Nagaraj
- Department of Clinical Pharmacy and PharmacologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Katja Taxis
- Unit of Pharmaco Therapy, Epidemiology and EconomicsGroningen Research Institute of PharmacyUniversity of GroningenGroningenThe Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and PharmacologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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Holmes-Truscott E, Cooke DD, Hendrieckx C, Coates EJ, Heller SR, Speight J. A comparison of the acceptability and psychometric properties of scales assessing the impact of type 1 diabetes on quality of life-Results of 'YourSAY: Quality of Life'. Diabet Med 2021; 38:e14524. [PMID: 33445223 DOI: 10.1111/dme.14524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 01/19/2023]
Abstract
AIMS To compare the acceptability, reliability and validity of five contemporary diabetes-specific quality of life (QoL) scales among adults with type 1 diabetes in the United Kingdom and Australia. METHODS Adults with type 1 diabetes (UK = 1139, Australia = 439) completed a cross-sectional, online survey including ADDQoL-19, DCP, DIDP, DSQOLS and Diabetes QoL-Q, presented in randomised order. After completing each scale, participants rated it for clarity, relevance, ease of completion, length and comprehensiveness. We examined scale acceptability (scale completion and user ratings), response patterns, structure (exploratory and confirmatory factor analyses) and validity (convergent, concurrent, divergent and known groups). To assess cross-country reproducibility, analyses conducted on the UK dataset were replicated in the Australian dataset. RESULTS Findings were largely consistent between countries. All scales were acceptable to participants: ≥90% completing all items, and ≥80% positive user ratings, except for DSQOLS' length. Scale structure was not supported for the DCP. Overall, in terms of acceptability and psychometric evaluation, the DIDP was the strongest performing scale while the ADDQoL-19 and Diabetes QoL-Q scales also performed well. CONCLUSIONS These findings suggest that the recently developed brief (7 items), neutrally worded DIDP scale is acceptable to adults with type 1 diabetes and has the strongest psychometric performance. However, questionnaire selection should always be considered in the context of the research aims, study design and population, as well as the wider published evidence regarding both the development and responsiveness of the scales.
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Affiliation(s)
- Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Vic., Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Vic., Australia
| | - Debbie D Cooke
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Vic., Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Vic., Australia
| | - Elizabeth J Coates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon R Heller
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Vic., Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Vic., Australia
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Okoro RN, Nduaguba SO. Community pharmacists on the frontline in the chronic disease management: The need for primary healthcare policy reforms in low and middle income countries. Exploratory Research in Clinical and Social Pharmacy 2021; 2:100011. [PMID: 35481111 PMCID: PMC9032016 DOI: 10.1016/j.rcsop.2021.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/31/2021] [Accepted: 04/11/2021] [Indexed: 11/02/2022] Open
Abstract
In low- and middle-income countries (LMICs), over 12 million people die yearly from chronic diseases and this number is expected to increase if concerted actions are not taken. The purpose of this paper is to highlight the roles and impact of community pharmacists in chronic disease management support and the need for policymakers in LMICs to reposition community pharmacists appropriately for this extended role. Recent findings have shown that community pharmacists are the most accessible healthcare providers to the members of the community. Published evidence have demonstrated that community pharmacists' interventions in chronic diseases significantly improve economic, clinical, and humanistic outcomes. However, they are not officially recognized as primary healthcare providers in LMICs. Therefore, there is need for policy reforms that will encourage strategic use of the clinical skills of community pharmacists as part of the primary healthcare team in LMICs.
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Nigussie S, Birhan N, Amare F, Mengistu G, Adem F, Abegaz TM. Rate of glycemic control and associated factors among type two diabetes mellitus patients in Ethiopia: A cross sectional study. PLoS One 2021; 16:e0251506. [PMID: 33974654 PMCID: PMC8112661 DOI: 10.1371/journal.pone.0251506] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/28/2021] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the rate of glycemic control and associated factors among type 2 diabetes mellitus patients at Dilchora Referral Hospital, Dire Dawa, Eastern Ethiopia. Methods A cross-sectional study was conducted from 13 May to 16 August 2019. Type 2 diabetic patients on follow up at Dilchora Referral Hospital who fulfilled the inclusion criteria of the study were included. Systematic random sampling was used to select study participants. Data was collected by a face-to-face interview and review of medical records. The primary outcome was the level of blood glucose during three consecutive visits. Poor glycemic control was defined as a blood sugar level of more than 154 mg/dL based on the average of measurements from three consecutive visits. Multivariate logistic regression analysis was used to identify determinants of glycemic control. Result A total of 394 participants responded to the interview and were included in the final analysis. The overall prevalence of poor glycemic control was 45.2% (95%CI: 40.6%-50.0%). Patients who were on oral anti-diabetic drug plus insulin had more than two times greater chance of poor glycemic control than patients on oral anti-diabetic drug alone: 2.177(95%CI:1.10–4.29). The odds of poor glycemic control in patients who did not understand the pharmacist’s instructions was two times higher than patients with good understanding of instructions 1.86(95%CI: 1.10–3.13). Patients who had poor level of practice were found to have poor glycemic control: 1.69(95% CI: 1.13–2.55). Conclusion The overall prevalence of poor glycemic control was high among type 2 diabetes patients. Oral anti-diabetic drugs in combination with insulin, lack of understanding of pharmacist’s advice, and poor practice of diabetic patients were significant factors of poor glycemic control. Pharmacists should reassure the understanding of patients before discharge during counseling. Optimization of the dose of antidiabetic medications and combination of oral hypoglycemic agents should be considered.
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Affiliation(s)
- Shambel Nigussie
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
- * E-mail:
| | - Nigussie Birhan
- Department of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Getnet Mengistu
- Pharmacology and Toxicology Unit, Pharmacy Department, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Fuad Adem
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
- Clinical and Health Science, University of South Australia, Adelaide, Australia
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Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJC, Walton RT. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database Syst Rev 2019; 12:CD011207. [PMID: 31808563 PMCID: PMC6896091 DOI: 10.1002/14651858.cd011207.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Community pharmacies are an easily accessible and cost-effective platform for delivering health care worldwide, and the range of services provided has undergone rapid expansion in recent years. Thus, in addition to dispensing medication, pharmacy workers within community pharmacies now give advice on a range of health-promoting behaviours that aim to improve health and to optimise the management of long-term conditions. However, it remains uncertain whether these health-promotion interventions can change the professional practice of pharmacy workers, improve health behaviours and outcomes for pharmacy users and have the potential to address health inequalities. OBJECTIVES To assess the effectiveness and safety of health-promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, six other databases and two trials registers to 6 February 2018. We also conducted reference checking, citation searches and contacted study authors to identify any additional studies. SELECTION CRITERIA We included randomised trials of health-promotion interventions in community pharmacies targeted at, or delivered by, pharmacy workers that aimed to improve the health-related behaviour of people attending the pharmacy compared to no treatment, or usual treatment received in the community pharmacy. We excluded interventions where there was no interaction between pharmacy workers and pharmacy users, and those that focused on medication use only. DATA COLLECTION AND ANALYSIS We used standard procedures recommended by Cochrane and the Effective Practice and Organisation of Care review group for both data collection and analysis. We compared intervention to no intervention or to usual treatment using standardised mean differences (SMD) and 95% confidence intervals (95% CI) (higher scores represent better outcomes for pharmacy user health-related behaviour and quality of life, and lower scores represent better outcomes for clinical outcomes, costs and adverse events). Interpretation of effect sizes (SMD) was in line with Cochrane recommendations. MAIN RESULTS We included 57 randomised trials with 16,220 participants, described in 83 reports. Forty-nine studies were conducted in high-income countries, and eight in middle-income countries. We found no studies that had been conducted in low-income countries. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. Duration of follow-up of interventions was often unclear. Only five studies gave details about the theoretical basis for the intervention, and studies did not provide sufficient data to comment on health inequalities. The most common sources of bias were lack of protection against contamination - mainly in individually randomised studies - and inadequate blinding of participants. The certainty of the evidence for all outcomes was moderate. We downgraded the certainty because of the heterogeneity across studies and evidence of potential publication bias. Professional practice outcomes We conducted a narrative analysis for pharmacy worker behaviour due to high heterogeneity in the results. Health-promotion interventions probably improve pharmacy workers' behaviour (2944 participants; 9 studies; moderate-certainty evidence) when compared to no intervention. These studies typically assessed behaviour using a simulated patient (mystery shopper) methodology. Pharmacy user outcomes Health-promotion interventions probably lead to a slight improvement in health-related behaviours of pharmacy users when compared to usual treatment (SMD 0.43, 95% CI 0.14 to 0.72; I2 = 89%; 10 trials; 2138 participants; moderate-certainty evidence). These interventions probably also lead to a slight improvement in intermediate clinical outcomes, such as levels of cholesterol or glycated haemoglobin, for pharmacy users (SMD -0.43, 95% CI -0.65 to -0.21; I2 = 90%; 20 trials; 3971 participants; moderate-certainty evidence). We identified no studies that evaluated the impact of health-promotion interventions on event-based clinical outcomes, such as stroke or myocardial infarction, or the psychological well-being of pharmacy users. Health-promotion interventions probably lead to a slight improvement in quality of life for pharmacy users (SMD 0.29, 95% CI 0.08 to 0.50; I2= 82%; 10 trials, 2687 participants; moderate-certainty evidence). Adverse events No studies reported adverse events for either pharmacy workers or pharmacy users. Costs We found that health-promotion interventions are likely to be cost-effective, based on moderate-certainty evidence from five of seven studies that reported an economic evaluation. AUTHORS' CONCLUSIONS Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change.
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Affiliation(s)
- Liz Steed
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Ratna Sohanpal
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Adam Todd
- Newcastle UniversitySchool of PharmacyQueen Victoria RoadNewcastle upon TyneUKNE1 7RU
| | - Vichithranie W Madurasinghe
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carol Rivas
- University College LondonDepartment of Social Science, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Elizabeth A Edwards
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
| | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise Sciences42 Old ElvetDurhamUKDH13HN
| | - Stephanie JC Taylor
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
| | - RT Walton
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and DentistryBlizard Institute, Yvonne Carter Building58 Turner StreetLondonUKE1 2AT
- Queen Mary University of LondonAsthma UK Centre for Applied ResearchLondonUK
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Presley B, Groot W, Pavlova M. Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis. Res Social Adm Pharm 2019; 15:1057-67. [DOI: 10.1016/j.sapharm.2018.09.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/21/2018] [Accepted: 09/29/2018] [Indexed: 11/20/2022]
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Aziz MM, Yang S, Masood I, Zhu S, Raza MA, Ji W, Anwar N, Saeed A, Fang Y. An assessment of counseling quality provided by community pharmacies to type 2 diabetic adult patients for oral therapy: a simulated patient study from Pakistan. Endocr J 2019; 66:233-239. [PMID: 30726787 DOI: 10.1507/endocrj.ej18-0429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study was conducted to assess quality of counseling provided to type 2 diabetic patients. For this cross-sectional study, a simulated patient method was applied in 562 selected community pharmacies of Punjab, Pakistan. A scenario for the metformin oral therapy was developed that illustrates direct counseling for adult diabetic patients. Counseling and communication skills were also assessed. Descriptive statistics and chi-square tests were used for analysis. Only 29.4% of simulated patients received medication counseling directly; 47.6% received it on request. About 32.8% of clients were referred to a physician without counseling. The most frequently provided information was dietary instruction (94.8%) and dose of therapy (84.5%). Only one quarter (25.3%) of simulated patients were asked about disease duration and similar rate (25.0%) was found for discussions of special warnings. The side effects, drug storage, drug-drug interactions and duration of therapy were ignored. Minimal information was provided about other medication during therapy (0.2%) and effect of medicine withdrawal (2.7%). About 59.5% simulated patients were instructed for compliance to medication. Counseling to type 2 diabetic patients in Pakistani community pharmacies is not very satisfactory. Pharmacies' staff have little focus on counseling. Professional training of staff could improve counseling and communication skills.
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Affiliation(s)
- Muhammad Majid Aziz
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, P. R. China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, P. R. China
- Global Health Institute, Xi'an Jiaotong University, Xi'an, P. R. China
- Shaanxi Center for Health Reform and Development Research, Xi'an, P. R. China
| | - Shimin Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, P. R. China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, P. R. China
- Global Health Institute, Xi'an Jiaotong University, Xi'an, P. R. China
- Shaanxi Center for Health Reform and Development Research, Xi'an, P. R. China
| | - Imran Masood
- Department of Pharmacy, Faculty of Pharmacy and Alternative Medicine, Railway Road Campus, Islamia University, Bahawalpur, Pakistan
| | - Shan Zhu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, P. R. China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, P. R. China
- Global Health Institute, Xi'an Jiaotong University, Xi'an, P. R. China
- Shaanxi Center for Health Reform and Development Research, Xi'an, P. R. China
| | - Muhammad Ali Raza
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, P. R. China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, P. R. China
- Global Health Institute, Xi'an Jiaotong University, Xi'an, P. R. China
- Shaanxi Center for Health Reform and Development Research, Xi'an, P. R. China
| | - Naveed Anwar
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amna Saeed
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, P. R. China
- The Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, P. R. China
- Global Health Institute, Xi'an Jiaotong University, Xi'an, P. R. China
- Shaanxi Center for Health Reform and Development Research, Xi'an, P. R. China
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Erku DA, Ayele AA, Mekuria AB, Belachew SA, Hailemeskel B, Tegegn HG. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study. Pharm Pract (Granada) 2017; 15:1026. [PMID: 28943985 PMCID: PMC5597801 DOI: 10.18549/pharmpract.2017.03.1026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/22/2017] [Indexed: 12/31/2022] Open
Abstract
Background: Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients. Objective: This study aims to evaluate whether a pharmacist-led medication therapy management, compared to the usual care, could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus. Methods: A prospective randomized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30, 2016. Patients in the control group (n=65) received the usual care while patients in the intervention group (n=62) received a personalized pharmacotherapeutic care plan and diabetes education. The two groups were compared by repeated measure ANOVA at 3 and 6-months with medication adherence (using Morisky medication adherence scale) and number of hospital admissions as the main outcome variables. Results: A total of 127 patients were included in the study. A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group (increased from 9.2% at baseline to 61% at 6 month) compared with the control group (increased from 13.2% at baseline (to 30.2% at 6 month; p-value<0.01). Furthermore, at the 6-month follow-up, only 23 patients in MTM group with poorly controlled blood glucose levels resulted in hospital admissions compared to 48 patients in non-MTM group, resulting in a 52.1% fewer hospital admissions (p< 0.001). Conclusions: The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus. Hence, policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes.
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Affiliation(s)
- Daniel A Erku
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
| | - Asnakew A Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
| | - Abebe B Mekuria
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
| | - Sewunet A Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
| | - Bisrat Hailemeskel
- Associate Professor and Director of Drug Information Services School of Pharmacy, College of Pharmacy, Nursing, and Allied Health Sciences, Howard University. Washington, DC (United States).
| | - Henok G Tegegn
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
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Erku DA, Belachew SA, Mekuria AB, Haile KT, Gebresillassie BM, Tegegn HG, Ayele AA. The role of community pharmacists in patient counseling and health education: a survey of their knowledge and level of involvement in relation to type 2 diabetes mellitus. Integr Pharm Res Pract 2017; 6:137-143. [PMID: 29354560 PMCID: PMC5774313 DOI: 10.2147/iprp.s140777] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The present study aimed at evaluating the knowledge and level of involvement of community pharmacists in the provision of patient counseling and health education services for patients with DM and perceived barriers that limit the delivery of such services. MATERIALS AND METHODS A self-administered questionnaire based-survey was undertaken from January to March, 2017 with 412 pharmacists working in community pharmacies in six cities of Amhara regional state of Ethiopia: Debre Markos, Gondar, Dessie, Bahir Dar, Woldya, and Debre Birhan. Descriptive statistics, ANOVA, and Student's t-test were employed to examine different variables. RESULTS Community pharmacists were found to have poor knowledge and low level of involvement, with an overall mean score of 11.54 and 2.06, respectively. A significant number of community pharmacists never practiced promoting smoking cessation (45.2%), counseling on good foot care techniques (33.7%), and counseling on the potential impact of over-the-counter and herbal drugs on DM management (34%). On the other hand, describing the right time to administer antidiabetic medications (46%) and counseling on suitable administration, handling, and storage of insulin (33.7%) were done more frequently. The main reported barriers to the delivery of these services were lack of knowledge or clinical skills, lack of access to additional training programs, and lack of personnel or resources. CONCLUSION The present study revealed a poor knowledge and low level of involvement in counseling and health education services for patients with DM. Lack of knowledge or clinical skills was the most commonly reported barrier for providing such services. In order to better integrate community pharmacies into future public health programs and optimize the contribution of pharmacists, interventions should focus on overcoming the identified barriers.
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Affiliation(s)
| | | | | | - Kaleab Taye Haile
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
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Tang TS, Yusuf FLA, Polonsky WH, Fisher L. Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework. Diabetes Res Clin Pract 2017; 126:286-302. [PMID: 28190527 DOI: 10.1016/j.diabres.2016.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.
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Affiliation(s)
| | | | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
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15
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Hughes JD, Wibowo Y, Sunderland B, Hoti K. The role of the pharmacist in the management of type 2 diabetes: current insights and future directions. Integr Pharm Res Pract 2017; 6:15-27. [PMID: 29354547 PMCID: PMC5774315 DOI: 10.2147/iprp.s103783] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Type 2 diabetes is a chronic disease occurring in ever increasing numbers worldwide. It contributes significantly to the cost of health globally; however, its management remains in the most part less than optimal. Patients must be empowered to self-manage their disease, and they do this in partnership with health care professionals. Whilst the traditional role of the pharmacist has been centered around the supply of medicines and patient counseling, there is an evergrowing body of evidence that pharmacists, through a range of extended services, may contribute positively to the clinical and humanistic outcomes of those with diabetes. Further, these services can be delivered cost-effectively. This paper provides a review of the current evidence supporting the role of pharmacists in diabetes care, whilst providing a commentary of the future roles of pharmacists in this area.
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Affiliation(s)
| | - Yosi Wibowo
- Centre for Medicines Information and Pharmaceutical Care (CMIPIC), Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
| | | | - Kreshnik Hoti
- School of Pharmacy, Curtin University, Perth, WA, Australia.,Department of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
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Pousinho S, Morgado M, Falcão A, Alves G. Pharmacist Interventions in the Management of Type 2 Diabetes Mellitus: A Systematic Review of Randomized Controlled Trials. J Manag Care Spec Pharm 2016; 22:493-515. [PMID: 27123912 PMCID: PMC10397609 DOI: 10.18553/jmcp.2016.22.5.493] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Diabetes mellitus is a major health problem that is growing rapidly worldwide. A collaborative and integrated team approach in which pharmacists can play a pivotal role should be sought when managing patients with diabetes. OBJECTIVE To identify and summarize the main outcomes of pharmacist interventions in the management of type 2 diabetes. METHODS PubMed, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials evaluating the effectiveness of any pharmacist intervention directed at patients with type 2 diabetes in comparison with usual care. Outcome measures of interest included glycosylated hemoglobin (Alc), blood glucose, blood pressure, lipid profile, body mass index (BMI), 10-year coronary heart disease (CHD) risk, medication adherence, health-related quality of life (HRQoL), and economic outcomes. The risk of bias in included studies was assessed using the Cochrane risk of bias tool. RESULTS Thirty-six studies were included in this systematic review, involving 5,761 participants. The studies evaluated the effects of several pharmacist interventions carried out in various countries and in different health care facilities, such as community pharmacies, primary care clinics, and hospitals. The number of studies reporting each outcome of interest varied. Alc was evaluated in 26 studies, of which 24 reported a greater reduction in this outcome in the intervention group compared with the control group, with the difference in change between groups ranging from -0.18% to -2.1%. Eighteen studies assessed change in systolic blood pressure, of which 17 studies reported a greater improvement in this outcome in the intervention group, with the difference in change between groups varying between -3.3 mmHg and -23.05 mmHg. For diastolic blood pressure, a greater effect was also observed in the intervention group in 14 out of 15 studies, with the difference in change between groups varying between -0.21 mmHg and -9.1 mmHg. Thirteen studies described total cholesterol as an outcome measure, of which 10 reported a greater improvement in this outcome in the intervention group, with the difference in change between groups ranging from +18.95 mg dL(-1) to -32.48 mg dL(-1). With regard to low-density lipoprotein cholesterol, a greater reduction in this parameter in the intervention group was documented in 12 out of 15 studies, with the difference in change between groups varying between +7.35 mg dL(-1) and -30 mg dL(-1). Similarly, favorable data were reported on high-density lipoprotein cholesterol in the intervention group in 9 out of 12 studies that assessed this outcome, with the difference in change between groups ranging from -5.8 mg dL(-1) to +11 mg dL(-1). Data on triglycerides were also reported in 12 studies, of which 9 reported a greater reduction in triglycerides levels in the intervention group, with the difference in change between groups varying between +12 mg dL(-1) and -62 mg dL(-1). Overall, a beneficial effect on BMI was also described in the intervention group in 12 out of 14 studies. Of note, in all 6 studies that estimated the 10-year CHD risk among study patients, a greater improvement in the intervention group versus the control group was found. In addition, pharmacist interventions also had a positive impact on medication adherence and HRQoL in most studies that ascertained these outcomes. Finally, although only 3 studies conducted a cost-effectiveness analysis, pharmacist interventions proved to be cost-effective. CONCLUSIONS The findings from this review clearly support the involvement of pharmacists as members of health care teams in the management of patients with type 2 diabetes. DISCLOSURES This systematic review was not funded. The authors declare that they have no conflicts of interest. Concept and study design were created by Pousinho, Morgado, and Alves. Pousinho took the lead in data collection, along with Alves, and data interpretation was performed by Pousinho, Falcão, and Alves. The manuscript was primarily written by Pousinho, along with Alves, and revised by Alves, Morgado, and Falcão.
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Affiliation(s)
- Sarah Pousinho
- CICS-UBI−Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Manuel Morgado
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, and Pharmaceutical Services of Hospital Centre of Cova da Beira, Covilhã, Portugal
| | - Amílcar Falcão
- CNC−Centre for Neuroscience and Cell Biology, and Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Gilberto Alves
- CICS-UBI−Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal, and CNC-Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
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Shrestha M, Maharjan R, Prajapati A, Ghimire S, Shrestha N, Banstola A. Assessment of knowledge and practice of community pharmacy personnel on diabetes mellitus management in Kathmandu district: a cross sectional descriptive study. J Diabetes Metab Disord 2015; 14:71. [PMID: 26396963 PMCID: PMC4578402 DOI: 10.1186/s40200-015-0205-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/17/2015] [Indexed: 01/24/2023]
Abstract
Background Pharmacists are the most reachable healthcare professionals to many chronically ill patients. It has been found that pharmacists see patients with diabetes up to five times more often than any other healthcare provider. Therefore, to provide quality health care to patients it is important that they have appropriate knowledge and practice on diabetes mellitus management. Thus, this study was conducted to assess the knowledge and practice of diabetes mellitus management among community pharmacy personnel involved in retail community pharmacies of Kathmandu. Methods Three hundred and fifteen community pharmacies, selected by systematic random sampling were surveyed by using pre-validated self-administered questionnaires. The first set of questionnaire evaluated the community pharmacy personnel’s diabetes knowledge based on a pre-validated 20-item questionnaire. The second set of questionnaire documented about the practice of community pharmacy personnel on diabetes mellitus management which contained 22 questions. Data was entered in EPI Data and analyzed by using SPSS version 20. Results This survey demonstrated that 76.5 % respondents had poor knowledge and 86.4 % had negative practice on diabetes mellitus (DM) management. Only 26.2 % respondents had good knowledge as well as good practice. 31.4 % of respondents had poor knowledge as well as poor practice on DM management. Conclusions Laws and regulations regarding community pharmacy personnel need to be implemented. There should be more advanced and experiment based training. Additionally, the provision for further education curriculum in pharmacy education should be implemented which should intensively include disease and proper management. Guidelines covering diabetes care should be distributed and implemented throughout community pharmacies.
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Affiliation(s)
- M Shrestha
- Department of Pharmacy, Valley College of Technical Sciences, Kathmandu, Nepal
| | - R Maharjan
- Department of Pharmacy, Valley College of Technical Sciences, Kathmandu, Nepal
| | - A Prajapati
- Department of Pharmacy, Valley College of Technical Sciences, Kathmandu, Nepal
| | - S Ghimire
- Department of Public Health, Valley College of Technical Sciences, Kathmandu, Nepal
| | - N Shrestha
- Department of Public Health, Valley College of Technical Sciences, Kathmandu, Nepal
| | - A Banstola
- Department of Pharmacy, Valley College of Technical Sciences, Kathmandu, Nepal
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Deshpande PR, Vantipalli R, Chaitanya Lakshmi CH, Rao EJ, Regmi B, Ahad A, Nirojini PS. Clinical pharmacists: The major support to Indian healthcare system in near future. J Pharm Bioallied Sci 2015; 7:161-74. [PMID: 26229349 PMCID: PMC4517317 DOI: 10.4103/0975-7406.160005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/20/2015] [Accepted: 05/04/2015] [Indexed: 11/04/2022] Open
Abstract
Pharmacy practice is still in the initial stages of development in India, but launching of Doctor of Pharmacy (PharmD) study program has brought serious discussions about clinical pharmacy in the country. As the profession is in budding stage in the country, the patients, physicians, nurses, other healthcare providers, recruiters in pharmaceutical industries, prospective students, and their parents have numerous questions about this profession and study course. The objective of this article is to create awareness about clinical pharmacy services (CPS) and to introduce the role of clinical pharmacists (CPs). After reading this article, one will know about the usefulness of CPs in the Indian healthcare system against the current flaws in the system. The article describes the role of CPs in the hospitals, in research, in pharmaceutical/contract research companies, in community service and it also tells about the related myths and facts. Prospective job opportunities for CPs, present challenges and the possible solutions are elaborated as well. In conclusion, CPs are going to be the major support to the Indian healthcare system in near future; the reasons being (1) CPS are beneficial in many ways to improve healthcare; CPS have already proved their importance in western countries (2) India was never officially and efficiently exposed to CPS; so launching of CPS shall revolutionize the country's healthcare scenario.
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Affiliation(s)
- Prasanna R Deshpande
- Department of Pharmacy Practice, Chalapathi Institute of Pharmaceutical Sciences, Acharya Nagarjuna University, Guntur, Andhra Pradesh, India ; Visiting Faculty, Government College of Pharmacy, Aurangabad, Maharashtra, India
| | - Raghuram Vantipalli
- Department of Pharmacy Practice, Chalapathi Institute of Pharmaceutical Sciences, Acharya Nagarjuna University, Guntur, Andhra Pradesh, India
| | - C H Chaitanya Lakshmi
- Department of Pharmacy Practice, Chalapathi Institute of Pharmaceutical Sciences, Acharya Nagarjuna University, Guntur, Andhra Pradesh, India
| | | | - Bishnu Regmi
- Department of Pharmacology/Hospital Pharmacy, College of Medical Sciences-Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Abdul Ahad
- Apollo Hospital, Bengaluru, Karnataka, India
| | - P Sharmila Nirojini
- Department of Pharmacy Practice, Chalapathi Institute of Pharmaceutical Sciences, Acharya Nagarjuna University, Guntur, Andhra Pradesh, India
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Fox LT, du Plessis J, Gerber M, van Zyl S, Boneschans B, Hamman JH. In Vivo skin hydration and anti-erythema effects of Aloe vera, Aloe ferox and Aloe marlothii gel materials after single and multiple applications. Pharmacogn Mag 2014; 10:S392-403. [PMID: 24991119 PMCID: PMC4078333 DOI: 10.4103/0973-1296.133291] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/28/2013] [Accepted: 05/28/2014] [Indexed: 01/01/2023] Open
Abstract
Objective: To investigate the skin hydrating and anti-erythema activity of gel materials from Aloe marlothiiA. Berger and A. ferox Mill. in comparison to that of Aloe barbadensis Miller (Aloe vera) in healthy human volunteers. Materials and Methods: Aqueous solutions of the polisaccharidic fractions of the selected aloe leaf gel materials were applied to the volar forearm skin of female subjects. The hydration effect of the aloe gel materials were measured with a Corneometer® CM 825, Visioscan® VC 98 and Cutometer® dual MPA 580 after single and multiple applications. The Mexameter® MX 18 was used to determine the anti-erythema effects of the aloe material solutions on irritated skin areas. Results: The A. vera and A. marlothii gel materials hydrated the skin after a single application, whereas the A. ferox gel material showed dehydration effects compared to the placebo. After multiple applications all the aloe materials exhibited dehydration effects on the skin. Mexameter® readings showed that A. vera and A. ferox have anti-erythema activity similar to that of the positive control group (i.e. hydrocortisone gel) after 6 days of treatment. Conclusion: The polysaccharide component of the gel materials from selected aloe species has a dehydrating effect on the skin after multiple applications. Both A. vera and A. ferox gel materials showed potential to reduce erythema on the skin similar to that of hydrocortisone gel.
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Affiliation(s)
- Lizelle T Fox
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Jeanetta du Plessis
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Minja Gerber
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Sterna van Zyl
- Centre for Pharmaceutical and Biomedical Services, Faculty of Health Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Banie Boneschans
- Centre for Pharmaceutical and Biomedical Services, Faculty of Health Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
| | - Josias H Hamman
- Centre of Excellence for Pharmaceutical Sciences, Faculty of Health Sciences, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
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Saba M, Diep J, Saini B, Dhippayom T. Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy. J Clin Pharm Ther 2014; 39:240-7. [DOI: 10.1111/jcpt.12131] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/16/2013] [Indexed: 12/22/2022]
Affiliation(s)
- M. Saba
- Faculty of Pharmacy; The University of Sydney; Sydney NSW Australia
| | - J. Diep
- Faculty of Pharmacy; The University of Sydney; Sydney NSW Australia
| | - B. Saini
- Faculty of Pharmacy; The University of Sydney; Sydney NSW Australia
| | - T. Dhippayom
- Faculty of Pharmaceutical Sciences; Naresuan University; Phitsanulok Thailand
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