Implementation and Evaluation of Clinical Pharmacy Services on Diabetes Care in an Endocrinology Clinic

Abstract

Purpose Diabetes impacts a significant population in the United States, with uncontrolled diabetes leading to serious adverse health effects and substantial cost to the healthcare system. Diabetes management by clinical pharmacy services (CPS) demonstrating positive clinical outcomes has been well-established in the primary care setting. However, there is little data evaluating the impact of CPS in specialty clinics such as endocrinology, which may provide additional opportunities for pharmacists to improve outcomes in a complex patient population. The purpose of this study is to describe the implementation of CPS in an ambulatory endocrinology clinic and to evaluate the impact of pharmacist care on diabetes management. Methods This was a retrospective, pre- post- descriptive study. Patients were enrolled into the study during a 6-month period and followed for a minimum of 6 months. The primary endpoint was mean change in hemoglobin A1c (HbA1c) between the pre- and post- pharmacist intervention phase. Secondary endpoints included blood pressure outcomes, statin appropriateness, rates of hospital and Emergency Department (ED) admissions due to severe hyper- or hypo- glycemia, and rates of retinal screening exams. Results A total of 101 patients were included in the study population. The mean baseline HbA1c was 9.11% and at six months 8.27%, with mean change of 0.84% (p-value <0.01). Descriptive statistics showed that blood pressure control, as well as statin and retinal screening rates, were high at baseline, with CPS making limited interventions in these areas. Conclusion This study demonstrated that pharmacist interventions in diabetes care is associated with improved HbA1c for a complex patient population in an endocrinology clinic.

Pharmacists-led diabetes care in Nigeria (2000-2022): A systematic review

“…The impact of pharmacist-led care/programs on treatment outcomes of patients with DM is globally proven using 8,9 RCTs , but the evidence is scanty in Nigeria. The results showed that over 50% (36 out of 62) of the studies were conducted between 2015 and 2022 and approximately 98% (61 out of 62) between 2008 and 2022.…”

“…Most of the studies (50) were populationbased, comprising of patients with T1DM, T2DM and a few non-diabetic individuals in one pre-diabetes study, while 12 articles reported outcomes of researches conducted among community and hospital pharmacists. Fifty three studies (53) were hospital-based, while eight (8) were conducted in community pharmacies and one (1) study involved the hospital and community settings. Outcomes measures for studies retained in the review include assessment of knowledge, attitude and DM self-practice {selfmanagement or monitoring of blood glucose (SMBG)}, pharmaceutical care knowledge, practice and barriers and health related quality of life.…”

“…This review found six 26,41,53,59,61,65 studies which covered different aspects of pharmacoeconomics, with a total of 676 participants and an 72 26,41,53,61,65 inter-facility based study . Five studies reported the annual cost of illness among people with diabetes, the mode of payment adopted by patients for their medication and 61 other healthcare consumptions and the impact of 26 pharmacist-led care on pharmacoeconomic parameters , 59 while a study estimated the annual cost of managing the comorbidity of DM and tuberculosis (8,604,819). The annual cost of illness for diabetic patients in Nigeria ranges between #194,067.66 and 268,572.81, while majority (80.8%) practiced out-of-packet mode of payment and there was significant correlation between age and cost of illness (p< 0.05).…”

“…It is therefore expected that the management of diabetes mellitus (DM) would require a multidisciplinary team approach, involving physicians, pharmacists, nurses, diabetes educators, nutritionists and other healthcare specialists to ensure optimal treatment outcomes including blood glucose control (less than 7% glycated haemoglobin concentration or less than 7mmols/L of fasting blood glucose levels), weight reduction (body 2 mass index: 18.5 kg/m and 24.9kg/m2), blood pressure (average of less than 140/80 mmHg) and controlled lipid concentrations (total cholesterol <5.2mmol/L, low density lipoprotein cholesterol <2.6mmol/L high density lipoprotein cholesterol >1.3mmol/L, triglycerides 5,6,7 <1.7mmol/L) . With the myriad of medications usually prescribed for DM treatment, especially type 2 diabetes mellitus (T2DM), the inclusion of pharmacists in diabetes care team is highly recommended to ensure optimisation of 8,9 care outcomes . The pharmacy-related services (PS) include prescription validation, patient education, medication adherence counselling, medication reconciliation, medication therapy management including identification and resolution of drug therapy problems, provision of drug therapy information to both patients and other healthcare professionals, pharmacovigilance, 10,11,12 medication dispensing and referrals .…”