Impact of a Medication Therapy Management Clinic on Glycosylated Hemoglobin, Blood Pressure, and Resource Utilization

Tilton, Jessica J.; Edakkunnathu, Mansi G; Moran, Kellyn M.; Vaysman, Anna Markel; DaPisa, Jessica L; Goen, Brianna M; Touchette, Daniel R.

doi:10.1177/1060028018794860

Cited by 18 publications

(40 citation statements)

References 17 publications

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“…This is consistent with studies conducted in Australia [ 32 ] and USA [ 33 ] that showed age and duration of diabetes are strongly associated with macro-vascular and microvascular events. Intervention brought about a reduction in HbA1c levels by about 0.92% from baseline and this is concordant with other numerous studies performed in pharmacist-managed ambulatory and community pharmacy diabetes care models [ 19 , 34 , 35 ]. The reduction is strongly attributed to the intervention, which targeted the optimization of medication therapy need, lifestyle modification and enhanced medication adherence through consultations.…”

Section: Discussionsupporting

confidence: 89%

“…Similar studies done elsewhere [ 39 , 40 ] reported a decrement following MTM service, with varied extent depending on guideline used for cut-off points, patients’ awareness to apply recommendations and other sociodemographic factors. Other clinical parameters including FBS and SBP were also reduced through the intervention as reported elsewhere [ 34 , 37 , 39 ].…”

Section: Discussionmentioning

confidence: 87%

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Impact of medication therapy management service on selected clinical and humanistic outcomes in the ambulatory diabetes patients of Tikur Anbessa Specialist Hospital, Addis Ababa, Ethiopia

et al. 2021

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Background Diabetes mellitus (DM) patients are at increased risk of developing drug therapy problems (DTPs). The patients had a variety of comorbidities and complications, and they were given multiple medications. Medication therapy management (MTM) is a distinct service or group of services that optimize therapeutic outcomes for individual patients. The study assessed the impact of provision of MTM service on selected clinical and humanistic outcomes of diabetes patients at the diabetes mellitus clinic of Tikur Anbessa Specialized Hospital (TASH). Methods A pre-post interventional study design was carried out at DM clinic from July 2018 to April 2019. The intervention package included identifying and resolving drug therapy problems, counseling patients in person at the clinic or through telephone calls, and providing educational materials for six months. This was followed by four months of post-intervention assessment of clinical outcomes, DTPs, and treatment satisfaction. The interventions were provided by pharmacist in collaboration with physician and nurse. The study included all adult patients who had been diagnosed for diabetes (both type I & II) and had been taking anti-diabetes medications for at least three months. Patients with gestational diabetes, those who decided to change their follow-up clinic, and those who refused to participate in the study were excluded. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive statistics, t-test, and logistic regressions were performed for data analyses. Results Of the 423 enrolled patients, 409 fulfilled the criteria and included in the final data analysis. The intervention showed a decrease in average hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and systolic blood pressure (SBP) by 0.92%, 25.04 mg/dl, and 6.62 mmHg, respectively (p<0.05). The prevalence of DTPs in the pre- and post-intervention of MTM services was found to be 72.9% and 26.2%, respectively (p<0.001). The overall mean score of treatment satisfaction was 90.1(SD, 11.04). Diabetes patients of age below 40 years (92.84 (SD, 9.54)), type-I DM (93.04 (SD, 9.75)) & being on one medication regimen (93.13(SD, 9.17)) had higher satisfaction score (p<0.05). Conclusion Provision of MTM service had a potential to reduce DTPs, improve the clinical parameters, and treatment satisfaction in the post-intervention compared to the pre-intervention phase.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 87%

Impact of medication therapy management service on selected clinical and humanistic outcomes in the ambulatory diabetes patients of Tikur Anbessa Specialist Hospital, Addis Ababa, Ethiopia

et al. 2021

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“…The effectiveness of interventions may depend on the delivery methods and frequency of intervention to patients rather than the type of provider who delivered the intervention. While studies included in this review did not consistently report frequency of patient communication between study arms, among those that were effective, several reported that the interventions involved regular in‐person or phone communication with a care team member either on a scheduled or as‐needed basis 13,27,44 …”

Section: Discussionmentioning

confidence: 99%

Strategies for overcoming therapeutic inertia in type 2 diabetes: A systematic review and meta‐analysis

Powell

Zaccardi

Beebe

et al. 2021

Diabetes Obesity Metabolism

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Aims To systematically investigate the effect of interventions to overcome therapeutic inertia on glycaemic control in individuals with type 2 diabetes. Materials and Methods We electronically searched for randomized controlled trials or quasi‐experimental studies published between January 1, 2004 and December 31, 2019 evaluating the effect of interventions on glycated haemoglobin (HbA1c) control. Characteristics of included studies and HbA1c difference between intervention and control arms (main outcome) were extracted. Interventions were grouped as: care management and patient education; nurse or certified diabetes educator (CDE); pharmacist; or physician‐based. Results Thirty‐six studies including 22 243 individuals were combined in nonlinear random‐effects meta‐regressions; the median (range) duration of intervention was 1 year (0.9 to 36 months). Compared to the control arm, HbA1c reduction ranged from: −17.7 mmol/mol (−1.62%) to −4.4 mmol/mol (−0.40%) for nurse‐ or CDE‐based interventions; −13.1 mmol/mol (−1.20%) to 3.3 mmol/mol (0.30%) for care management and patient education interventions; −9.8 mmol/mol (−0.90%) to −6.6 mmol/mol (−0.60%) for pharmacist‐based interventions; and −4.4 mmol/mol (−0.40%) to 2.8 mmol/mol (0.26%) for physician‐based interventions. Across the included studies, a reduction in HbA1c was observed only during the first year (6 months: −4.2 mmol/mol, 95% confidence interval [CI] −6.2, −2.2 [−0.38%, 95% CI −0.56, −0.20]; 1 year: −1.6 mmol/mol, 95% CI −3.3, 0.1 [−0.15%, 95% CI −0.30, 0.01]) and in individuals with preintervention HbA1c >75 mmol/mol (9%). Conclusions The most effective approaches to mitigating therapeutic inertia and improving HbA1c were those that empower nonphysician providers such as pharmacists, nurses and diabetes educators to initiate and intensify treatment independently, supported by appropriate guidelines.

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“…Among the numerous studies that have evaluated the benefits of pharmacist inclusion in T2DM management, there is consistent evidence that suggests that pharmacists can help improve clinical outcomes. [7][8][9][10] However, as pharmacists are becoming more integral to multidisciplinary health care teams in diabetes management, it is crucial not only to measure clinical outcomes but also to identify the particular activities that are driving change. This process is facilitated by understanding the perceptions of the patients who use the services.…”

Section: Discussionmentioning

confidence: 99%

“…and health-related quality of life. [7][8][9][10][11] These studies have included people from a broad demographic distribution, revealing that the improved outcomes extend to those most in need: underserved, minority populations with poorly controlled diabetes. 12,13 Whereas pharmacists working in multidisciplinary diabetes health care teams are helpful in improving outcomes, patient experiences of receiving care within these models are missing.…”

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confidence: 99%

Clinical pharmacists in diabetes management: What do minority patients with uncontrolled diabetes have to say?

Nabulsi¹,

Yan²,

Tilton³

et al. 2020

Journal of the American Pharmacists Association

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Objective: Clinical pharmacist support for patients with type 2 diabetes mellitus (T2DM) can optimize patient outcomes and medication adherence. However, there is limited understanding of what pharmacist roles patients perceive as most helpful in T2DM management interventions. This study describes experiences of minority patients with uncontrolled T2DM in terms of perceived pharmacist helpfulness and specific roles found to be most helpful within diabetes management. Design: A secondary analysis of a 2-year randomized, crossover trial was conducted. Setting and participants: This study included 244 African American and Hispanic adults with uncontrolled T2DM who received clinical pharmacist support within a team-based model. Outcome measures: The patients completed a mixed-methods survey regarding their experience with the intervention that included a general helpfulness rating on a 10-point unipolar Likert scale and described the support qualitatively, including their perception of the pharmacist roles. Thematic analysis guided coding of the responses. Results: One hundred forty-seven (60%) patients completed the survey and had at least 1 encounter with a clinical pharmacist. Of these, 108 (74%) were African American, 39 (27%) were Hispanic, and 101 (69%) were women. The median rating of clinical pharmacist helpfulness was 10 (very helpful). Only 10 (7%) participants rated pharmacist helpfulness as 1 (not at all helpful). "Medication education and management" was the most frequently perceived supportive role of the clinical pharmacists, followed by "nonemedication-related patient education," "social support," and "care coordination." Miscommunication related to scheduling was the most common reason cited for not meeting with the clinical pharmacist. Conclusion: This sample of minority patients with uncontrolled T2DM recognized many roles outlined within the American Pharmacists Association Medication Therapy Management framework. Patient experiences with clinical pharmacist T2DM support are crucial for developing effective programs, maximizing patient engagement, satisfying patient needs, and ensuring that a program's intended purpose aligns with the patient perspective.

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Impact of a Medication Therapy Management Clinic on Glycosylated Hemoglobin, Blood Pressure, and Resource Utilization

Cited by 18 publications

References 17 publications

Impact of medication therapy management service on selected clinical and humanistic outcomes in the ambulatory diabetes patients of Tikur Anbessa Specialist Hospital, Addis Ababa, Ethiopia

Impact of medication therapy management service on selected clinical and humanistic outcomes in the ambulatory diabetes patients of Tikur Anbessa Specialist Hospital, Addis Ababa, Ethiopia

Strategies for overcoming therapeutic inertia in type 2 diabetes: A systematic review and meta‐analysis

Clinical pharmacists in diabetes management: What do minority patients with uncontrolled diabetes have to say?

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