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

Abstract

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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“…A review of the clinical activities performed by pharmacists in diabetes management found they most commonly included health and medicationrelated education, lifestyle counselling, and the development of individualized care plans and goal setting. Other clinical activities included review of laboratory records, medication review and dose adjustments, and optimization of medication adherence [21]. While there is considerable heterogeneity in activities across different settings [21], systematic reviews and meta-analyses have shown pharmacist-led interventions for patients with diabetes are associated with improved clinical outcomes [16,17] and lower healthcare costs [17] compared to usual care.…”

“…Other clinical activities included review of laboratory records, medication review and dose adjustments, and optimization of medication adherence [21]. While there is considerable heterogeneity in activities across different settings [21], systematic reviews and meta-analyses have shown pharmacist-led interventions for patients with diabetes are associated with improved clinical outcomes [16,17] and lower healthcare costs [17] compared to usual care. Similar outcomes have been reported in the asthma literature, where collaboration between pharmacists and physicians has been cost-effective while leading to improvements in asthma symptoms and severity, and increases in patient knowledge [19].…”