Impact of pharmacist-directed counseling and message reminder services on medication adherence and clinical outcomes in type 2 diabetes mellitus

Abstract

Introduction: Medication nonadherence is the most common issue observed in the management of diabetes because of complex and lifelong therapy. The study aimed to assess the effect of pharmacist-directed counseling and daily text message reminder on medication adherence and clinical profile of patients with type II diabetes. Materials and Methods: This prospective, open-labeled, randomized control trial was carried out in outpatient medical department of a secondary care referral hospital. A total of 330 patients who met study criteria were enrolled and randomized into an intervention group ( n = 165), received counseling and daily messages about medication intake and control group ( n = 165), and usual care by physician. Medication adherence and clinical outcomes such as glycosylated hemoglobin (HbA1C), systolic blood pressure (SBP), low-density lipoprotein (LDL) cholesterol, triglyceride (TG) levels, and body mass index (BMI) were recorded at baseline and follow-up visits. Two-sample Wilcoxon rank sum test was used to compare the mean difference of medication adherence and paired t -test was used to compare clinical outcomes. Results and Discussion: The mean age of intervention and control groups were 57.1 ± 8.55 and 58.5 ± 8.53 years, respectively. The mean difference of medication adherence from baseline to second follow-up visit was significantly more in intervention group (12.2 ± 7.1%) compared to that in control group (0.75 ± 10.2 %) with a P < 0.001. From baseline to second follow-up visit, HbA1C (7.79 ± 0.67 to 6.91 ± 0.83 %), SBP (136.75 ± 20.09 to 126.23 ± 18.22 mm Hg), and LDL cholesterol (104.14 ± 26.23 to 98.29 ± 20.87 mg/dL) levels were significantly reduced in intervention group compared to that in control group with a P < 0.01. No significant improvement was observed in TG (169± 33.71 to 168 65 ± 33.90 mg/dL) and BMI (27.9 ± 4.21 to 27.1 ± 3.12 Kg/m 2 ) levels from baseline to second follow-up visit. Conclusion: Pharmacist-directed patient counseling combined with message reminder showed a greater effect on the improvement of medication adherence and control of glycemia, blood pressure, and lipid profile in diabetes.

Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

“…For this parameter, the difference in change between both groups ranged from +2.1 mg/dL to -27 mg/dL, and was reported as statistically significant in only seven studies (33.3%). 27 , 29 , 35 , 39 , 40 , 45 , 57 …”

Health system interventions for adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

“…performed by pharmacists such as care coordination, medication review and counseling, and prescription suggestions to physicians [28,[33][34][35]37,38,41,42,47,48,50,51,55,57]. All pharmacist task-sharing interventions incorporated diabetes self-management education, but no trial included education alone.…”

“…All pharmacist task-sharing interventions incorporated diabetes self-management education, but no trial included education alone. Seven interventions included counseling and reminders through telephone calls or text messages [34,35,38,39,41,55,57], and a study in Iran incorporated only telephone calls with no face-to-face encounters [50]. No intervention involved pharmacists independently prescribing or titrating medications.…”

“…No intervention involved pharmacists independently prescribing or titrating medications. All 11 of the studies that described the study setting were conducted in an urban area [33,35,37,38,41,42,48,50,51,55,57]. The intensity of interventions was incompletely reported but ranged from 3 to 16 telephone calls or face-toface visits.…”

Clinical Pharmacists in Chronic Care

“…A mobile phone text message can serve as a simple and cost-effective option in improving medication adherence and clinical outcomes by providing information between clinic visits has been reported [73,74]. A report from the National Diabetes Commission suggested that an inappropriate attitude of health care professionals toward diabetes could lead to poor patient outcomes [75]. In educational program, a clinical or community pharmacist can improve adherence by providing medication consultation service, creating an individualized patient schedule on administration times and dosage of each medication, educating the patient on the importance of medication adherence, dietary adherence and exercise on better glycemic control, giving advice on how to reduce adverse effects of medications, and also by teaching how to take medications in the holy month of Ramadan or other religious fasting, and how to use pill boxes and diary logs to reduce forgetfulness.…”