Long-term clinical and cost-effectiveness of collaborative care in people with uncontrolled type 2 diabetes mellitus and polypharmacy: A multicenter randomized controlled trial

Xu, Yuan-Chen; Tan, Cheryl Wei Yan; Tsou, Keith Yu Kei; Tan, David Hsien Yung; Gallagher, Paul; Lee, Joyce Yu‐Chia

doi:10.1016/j.pcd.2021.12.013

Cited by 4 publications

(19 citation statements)

References 27 publications

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“…Moreover, given the importance to propose a treatment tailored on older patients with diabetes and polypharmacy, the deintensification of antidiabetic therapy using long-acting medications and the simplification of the diabetes management through practical, pharmacological or dietary strategies should be always considered [ 26 , 42 ]. Evidence on the effectiveness of the above-mentioned strategies from interventional studies is still scarce [ 43 , 44 ]. In particular, in the randomized controlled trial of Xu et al, a collaborative care model showed to improve the achievement of the glycemic targets and reduce the related medical costs, in diabetic patients with polypharmacy [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Evidence on the effectiveness of the above-mentioned strategies from interventional studies is still scarce [ 43 , 44 ]. In particular, in the randomized controlled trial of Xu et al, a collaborative care model showed to improve the achievement of the glycemic targets and reduce the related medical costs, in diabetic patients with polypharmacy [ 43 ]. Similarly, in another trial on individuals with multimorbidity including diabetes, an interprofessional team-based approach seemed to lead to better diabetes and blood pressure control [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and impact of polypharmacy in older patients with type 2 diabetes

et al. 2022

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Background Polypharmacy is a prevalent condition in older adults, especially those with multiple chronic diseases, and has been largely associated with adverse outcomes, including disability, hospitalizations, and death. Aims This systematic review focused on diabetes and aimed to investigate the prevalence and impact of polypharmacy in older adults affected by such disease. Methods Observational (either cross-sectional or longitudinal) or experimental studies investigating the frequency and impact of polypharmacy in older adults with diabetes were identified from scientific databases and grey literature until August 2021. The prevalence and the 95% Confidence Interval (95% CI) of polypharmacy in older people with diabetes were summarized by a random-effects meta-analysis. Results From a total of 1465 records, 9 were selected for the qualitative synthesis, and 8 for the quantitative synthesis. Most studies defined polypharmacy using a cut-off for the minimum number of medications ranging from 4 to 6 drugs/day. The pooled prevalence of polypharmacy in older people with diabetes was 64% (95% CI 45–80%). Considering studies that used the same definition of polypharmacy (i.e. ≥ 5 drugs/day), the pooled prevalence was 50% (95% CI 37–63%). The between-studies heterogeneity was high. Across the selected studies, polypharmacy seemed to negatively influence both diabetes-specific (poor glycemic control and risk of hypoglycemia) and health-related (risk of incident falls, syncope, hospitalization, and death) outcomes. Conclusion This systematic review confirms the high prevalence of polypharmacy in older people with diabetes and its strong impact on several health-related outcomes, including mortality. These results strengthen the need to improve care strategies for management of these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence and impact of polypharmacy in older patients with type 2 diabetes

et al. 2022

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“…A total of 1468 articles were identified (n = 1456 from databases; n = 12 from manual search of references) of which 331 were duplicates and 2 articles were not accessible by the authors, leaving 1125 articles screened for eligibility (Figure 1). Thirty articles were reviewed after 1095 articles were excluded 11–40 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Five studies included the address of DRPs as part of the intervention, two of them were cohort studies and three RCT 15,23,37,39,40 . Four studies (three RCT and one cohort study) evaluated clinical outcomes such as HbA1c, blood pressure, LDL, and triglyceride and all four studies reported significant improvements in clinical outcomes over the study period 15,23,39,40 . One study (cohort design) assessed the incidences and resolution of DRPs, and found that the pharmacist‐involved collaborative care team fully or partially resolved 61.1% of all identified DRPs 30 .…”

Section: Resultsmentioning

confidence: 99%

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Mapping the evidence on clinical activities and outcome measures of pharmacist‐involved collaborative care models in managing diabetes: A scoping review

Lum

Gallagher

et al. 2023

J Am Coll Clin Pharm

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Objective This scoping review aimed to map the extent and range of evidence on the clinical activities performed and types of outcomes evaluated in pharmacist‐involved collaborative care models for diabetes management. Methods This scoping review was guided by the five‐stage methodological framework developed by Arksey and O'Malley. Publications in the English language were identified from PubMed, EMBASE, and CINAHL and the databases were searched from inception to 31 May 2022. Abstracts, conference proceedings, brief reports, and commentaries were excluded. Key search terms were “interprofessional collaborative care,” “pharmacist,” “type 2 diabetes,” and “outcome.” Microsoft Excel was used for data charting and descriptive computations were conducted using the Statistical Package for Social Sciences. Results A total of 208 articles were identified, and after excluding 178 articles (and duplicates), 30 articles were reviewed. Most of the studies (56.7%) were conducted in the United States of America and were randomized controlled trials (50.0%) followed by cohort studies (36.7%). The most common clinical activity identified was provision of health‐ and medication‐related education (80.0%), followed by lifestyle counseling (76.7%) and development of individualized care plan and goal setting (63.3%). Other clinical activities were review of laboratory records, medication review and dose adjustments, optimization of medication adherence, minimization of drug‐related problems, identify referral to other care providers, and conduct physical assessments. HbA1c was the most reported clinical outcome (n = 26, 86.7%), with 11 studies evaluating patient‐reported outcomes (PROs) such as medication adherence, diabetes knowledge, self‐care, quality of life, diabetes distress, and treatment satisfaction. Conclusion Clinical activities performed by pharmacists were heterogenous across studies and based on patients' needs. While pharmacist‐involved collaborative care models were posited as person‐centric outcome, PROs were lacking in most studies. Evaluating PROs are essential in guiding the implementation of such people‐centric care models.

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Impact of Interprofessional Education and Collaborative Practice on Healthcare Outcomes: Evidence and Implications

Alshogran,

Almansour

2023

Novel Health Interprofessional Education and Collaborative Practice Program: Strategy and Implementation

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Long-term clinical and cost-effectiveness of collaborative care in people with uncontrolled type 2 diabetes mellitus and polypharmacy: A multicenter randomized controlled trial

Cited by 4 publications

References 27 publications

Prevalence and impact of polypharmacy in older patients with type 2 diabetes

Prevalence and impact of polypharmacy in older patients with type 2 diabetes

Mapping the evidence on clinical activities and outcome measures of pharmacist‐involved collaborative care models in managing diabetes: A scoping review

Impact of Interprofessional Education and Collaborative Practice on Healthcare Outcomes: Evidence and Implications

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