Efficacy of a telephone-based intervention among patients with type-2 diabetes; a randomized controlled trial in pharmacy practice

Abstract

Background Pharmacists' interventions to improve outcomes of diabetes management have been promising. However, evidence on using telephone-based interventions in pharmacy practice are limited, particularly in developing countries. Objective To evaluate the efficacy of a telephone-based intervention to improve care and clinical outcomes in type-2 diabetes. Setting A referral community pharmacy and drug information center. Method We conducted a two-armed randomized controlled trial on 100 patients with type-2 diabetes. The intervention consisted of 16 telephone calls in 3 month by a trained pharmacist working in an academic drug information center, while the control group received usual care. Before random allocation, patients attended a live education session delivered by pharmacists to learn the basics of diabetes care and to confirm the eligibility criteria. Assessments were performed at baseline, month-3 (after intervention), and month-9 (follow-up). Main outcome measure Hemoglobin A1c (HbA1c). Results Eighty four patient completed the trial. Baseline variables were comparable between the two groups and the baseline value of hemoglobin A1c was 8.00 ± 1.44 in the study population. HbA1c was significantly improved in both groups at month-3 (6.97 ± 1.41 vs. 7.09 ± 1.78) and remained steady at month-9 (6.96 ± 1.44 vs. 7.26 ± 1.85). Lipid profile showed small improvements in the intervention group but was not significant. The adherence score and self-care score improvement was significantly higher in the intervention group at month-3 and were maintained at month-9. Conclusion Medication adherence and self-care significantly improved in the telephone-based intervention group. However, the improvement of clinical outcomes might have been diluted due to the live diabetes education session.

Understanding Nonadherence with Hydroxychloroquine Therapy in Systemic Lupus Erythematosus

“…FaceTime has also been used successfully to enforce directly observed therapy remotely, increasing adherence to mycophenolate mofetil in pediatric patients with SLE 18 . Studies are under way to explore the use of mobile health technologies in other chronic diseases such as hypertension 19,20,21 , diabetes 20,22 , cancer treatment 23 , and human immunodeficiency virus 24 , and the findings of these studies may be applicable to the SLE population in enhancing medication adherence.…”

A systematic review exploring characteristics of lifestyle modification interventions in newly diagnosed type 2 diabetes for delivery in community pharmacy†

“…With evidence regarding the role of community pharmacists in established diabetes demonstrating positive clinical outcomes, there is potential for community pharmacists to be involved in the management of people newly diagnosed with type 2 diabetes. [33][34][35][36][37][38] In order to explore whether community pharmacy has the potential to provide adequate support to patients who are newly diagnosed and medication na€ ıve, there is a need to explore the characteristics of effective interventions in this population. The present systematic review aimed to examine the characteristics of successful diet and lifestyle interventions designed for patients with newly diagnosed T2DM such as type of intervention, style of delivery, resources, training requirements and settings in order to determine elements that have the potential to be delivered in the community pharmacy setting.…”

Optimising health outcomes via pharmacist delivered telehealth medicines management: a systematic review

“…An initial face-to-face consultation was a component of almost half the studies. 22,25,29,33 Most interventions included at least one adjuvant such as home monitoring, web-based portals, text message and written materials ( Table 1). Of the pharmacist interventions, pharmacists in three studies had prescriptive authority to adjust and change medicines 16,25,34 and pharmacists in three studies could order laboratory results.…”

“…16,24,34 Other pharmacist telehealth interventions also comprised recommendations for medicine optimisation to the primary care practitioner. 18,20,22,24,29,30 Usual care differed depending on the study. In four studies, usual care was defined as the care at the discretion of the primary care practitioners, of which the studies did not further elaborate.…”

“…18,[23][24][25] Usual care in three studies were at the discretion of the primary care practitioners with written or face-to-face education provided for all study participants. 16,29,30 One study compared usual care, which was at the discretion of the primary care provider, with two active intervention arms, one of which involved pharmacist telehealth. 20 The other three studies defined usual care as standard pharmacist counselling on discharge, nurse-led telehealth and care provided at an outpatient nurse-physician run diabetes clinic.…”