Compared benefits of educational programs dedicated to diabetic patients with or without community pharmacist involvement

Abstract

Background: International guidelines on diabetes control strongly encourage the setting-up of therapeutic educational programs (TEP). However, more than half of the patients fail to control their diabetes a few months post-TEP because of a lack of regular follow-up by medical professionals. The DIAB-CH is a TEP associated with the follow-up of diabetic patients by the community pharmacist. Aim: To compare the glycated hemoglobin (HbA1c) and body mass index (BMI) in diabetic patients of Control (neither TEP-H nor community pharmacist intervention), TEP-H (TEP in hospital only) and DIAB-CH (TEP-H plus community pharmacist follow-up) groups. Methods: A comparative cohort study design was applied. Patients included in the TEP-H from July 2017 to December 2017 were enrolled in the DIAB-CH group. The TEP-H session was conducted by a multidisciplinary team composed of two diabetologists, two dieticians and seven nurses. The HbA1c level and the BMI (when over 30 kg/m2 at M0) of patients in Control (n = 20), TEP-H (n = 20) and DIAB-CH (n = 20) groups were collected at M0, M0 + 6 and M0 + 12 months. First, HbA1c and BMI were compared between M0, M6 and M12 in the three groups with the Friedman test, followed by the Benjamini-Hochberg post-test. Secondly, the HbA1c and BMI of the three groups were compared at M0, M6 and M12 using the Kruskal-Wallis test. Findings: While no difference in HbA1c was measured between M0, M6 and M12 in the Control group, Hb1Ac was significantly reduced in both TEP-H and DIAB-CH groups between M0 and M6 (P = 0.0072 and P = 0.0034, respectively), and between M0 and M12 only in the DIAB-CH group (P = 0.0027). In addition, a significant decrease in the difference between the measured HbA1c and the target assigned by diabetologists was observed between M0 and M6 in both TEP-H and DIAB-CH groups (P = 0.0072 and P = 0.0044, respectively) but only for the patients of the DIAB-CH group between M0 and M12 (P = 0.0044). No significant difference (P > 0.05) in BMI between the groups was observed. Conclusion: The long-lasting benefit on glycemic control of multidisciplinary group sessions associated with community pharmacist-led educational interventions on self-care for diabetic patients was demonstrated in the present study. There is thus evidence pointing to the effectiveness of a community/hospital care collaboration of professionals on diabetes control in primary care.

Efektivitas Edukasi Obat untuk Pasien Diabetes Mellitus pada Masa Pandemi Covid-19 di Puskesmas Kecamatan Cempaka Putih, Jakarta Pusat

“…Studi tersebut menggarisbawahi pentingnya kolaborasi antara apoteker di rumah sakit dengan apoteker komunitas dalam penanganan pasien selanjutnya. Apoteker klinis di rumah sakit umumnya hanya dapat memberikan pelayanan kefarmasian secara terbatas saat pasien DM menjalani rawat inap, tetapi ketika pasien kembali ke rumah, terjadi kesenjangan dalam perawatan [26]. Studi meta analisis lainnya menyebutkan bahwa terdapat sejumlah keterlibatan apoteker yang berdampak positif terhadap manajemen penyakitt diabetes mellitus yaitu adanya proses umpan balik terapi DM dengan dokter, penetapan target kontrol glikemik secara individu, review penggunaan obat dan upaya peningkatan kepercayaan pasien terhadap obat yang dikonsumsinya [27].…”