Pilot and Feasibility of Combining a Medication Adherence Intervention and Group Diabetes Education for Patients with Type-2 Diabetes

Abstract

Introduction: Controlling diabetes typically requires self-management and medications. Community pharmacists are positioned to support patients with both. Methods: This study assessed the feasibility and potential benefit of combining pharmacist-provided group diabetes education (up to eight sessions) and medication synchronization using a three-group design. Data were collected using pre–post paper surveys and electronic health record data. One group received both education and synchronization services, another group received medication synchronization only, and a third served as control. Results: Of 300 contacted patients, eighteen patients participated in group diabetes education, 14 had medication synchronization only, and 12 comprised a control group. There was little change in HbA1c over the study period. Medication adherence appeared to be positively aided by medication synchronization, although all groups started with high adherence. Some medication beliefs and self-care activities may have been positively impacted by group diabetes education. Both groups receiving medication synchronization were satisfied. Conclusions: Participants strongly agreed they would recommend group diabetes education from the study pharmacy to a friend and were satisfied with medication synchronization; however, it was difficult to tell if there was a synergistic effect by combining the two services. Reimbursement for diabetes education was not obtained despite multiple attempts, hindering sustainability.

Systematic review of the impact of medication synchronization on healthcare utilization, economic, clinical, and humanistic outcomes

“…Characteristics of included studies are provided in Table C1. Study designs varied, with 1 (4%) randomized controlled trial, 24 3 (11%) quasiexperimental studies, 7,25,26 10 (41%) retrospective cohort studies, [27][28][29][30][31][32][33][34][35][36] 4 (15%) pre-post studies, 37-40 1 (4%) prospective cohort study, 41 1 (4%) cost-benefit analysis, 42 6 (19%) cross-sectional surveys, [43][44][45][46][47][48] and 1 (4%) chart review. 10 Med-sync was provided at different pharmacy settings, such as independent, chain, outpatient, and mail-order pharmacies.…”

“…Of the 27 studies, 26 were observational and had moderate to serious bias due to confounding and bias in selection of participants for the study (Table B1). 7,10,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][43][44][45][46][47] All the non-randomized studies had a moderate bias in measurement of outcomes, while two studies had serious bias in measurement of outcomes. 42,48 Confounding was commonly seen as most of the med-sync programs were in conjunction with other programs, such as Medication Therapy Management (MTM), home delivery services, medication reconciliation, adherence packaging, or educational interventions.…”

“…A total of 21 studies with clinical outcomes were identified. 7,10,[24][25][26][27][28][29][30][31][32][33][34][35][37][38][39][43][44][45][46] Out of these studies, adherence was the most commonly measured outcome (n = 16). 7,[24][25][26][28][29][30][31][32][33]35,[37][38][39][44][45][46] The study group size ranged from 8 to 126 597.…”

“…There were four studies that evaluated humanistic outcomes of patient or provider satisfaction of med-sync programs. Three studies conducted surveys at a single pharmacy location [46][47][48] and one study…”

Feasibility study of a digitalized nurse practitioner-led intervention to improve medication adherence in type 2 diabetes patients in Dutch primary care

“…Refill adherence is generally considered a reliable and objective measure of medication adherence[ 24 ], but limitations when used as eligibility criterion have been reported. For example, when a patient’s dose is reduced or halted without a new prescription being written, patients seemed non-adherent to medication based on refill adherence, while in reality they are not [ 25 ]. Our study adds to these findings by showing that the repeat dispensing service of pharmacies also decreases the reliability of refill adherence to identify patients that are non-adherent.…”