The Evaluation of home medication review for patients with type 2 diabetes mellitus by community pharmacists: a randomised controlled trial

Abstract

Background: Successful diabetes treatment requires commitment and understanding of disease management by the patients.
 Objective: This trial aimed to evaluate the programme effectiveness of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and reducing medication wastage.
 Methods: A randomised controlled trial was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The cost of medication wastage was calculated based on the total missed dose by the T2DM patients multiplied by the cost of medication. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively.
 Results: No significant difference was observed in the demographic and anthropometric data at baseline between the two groups except for fasting blood glucose (FBG). There was a significant reduction in the HbA1c (-0.91%) and FBG (-1.62mmol/L) over the study period (p<0.05). A similar observation was noted in diastolic blood pressure (DBP) and total cholesterol (TC) but not in high-density lipoprotein (HDL), and anthropometric parameters. Both utility value and Michigan Diabetes Knowledge Test (MDKT) scores increased significantly over time. As for the intervention group, significant changes in PCAR (p<0.001) and the number of DRP (p<0.001) were noted.
 Conclusions: HMR-CP significantly improved the glycaemic control, QoL, medication adherence, and knowledge of T2DM patients as well as reduced the number of DRP and cost of medication wastage. However, the impact of HMR-CP on certain clinical and anthropometric parameters remains inconclusive and further investigation is warranted.

Medication Adherence of Persons with Type 2 Diabetes in Malaysia: A Scoping Review and Meta-Analysis

“… 60 Medication adherence was measured using a self-developed questionnaire in 6 studies. 22 , 25 , 26 , 61 - 63 Three studies used pill count 30 , 64 , 65 and the medication dose, frequency, indication and time score (DFIT). 66…”

Primary Health Care: Roles of Community Pharmacists in Low- and Middle-Income Countries—A Systematic Review

“…46,69,72,109 Another ve studies described medication reviews and follow-up for patients with chronic diseases. 45,71,74,93,114 Thirteen studies outlined self-care and point-of-care testing as well as medication adherence in patients with type 2 diabetes, 33,34,37,53,57,64,66,68,84,91,96,108,110 while patient counselling, identi cation and resolution of medication-related problems in patients with type 2 diabetes mellitus were identi ed in two other studies. 115,116 Asthma self-management was reported in two studies.…”

“…118 Barriers to primary care services For barriers to effective delivery of these services, 23 studies identi ed a lack of government policies for the integration of retail pharmacies into the national primary care framework as a major barrier to providing primary care services. 38,45,48,52,59,66,67,69,72,74,75,81,86,87,91,93,96,98,[100][101][102][103]110 Lack of time was reported as a barrier to PHC activities in ten studies. 33,36,53,62,65,74,88,106,114,117 Six studies highlighted a lack of effective collaboration in patient care, especially with physicians.…”

“…33,36,53,62,65,74,88,106,114,117 Six studies highlighted a lack of effective collaboration in patient care, especially with physicians. 66,71,78,93,96,106 Limited knowledge and specialised training in tuberculosis, asthma, migraine management, antibiotic stewardship, pharmacovigilance during pregnancy, abortion, medication use review, CAM and vaccines were identi ed by nine other studies. 36,70,72,73,94,104,105,112,114 "Ethical dilemma" was identi ed by three reports.…”

“…Seven studies highlighted the need for effective collaboration between community pharmacists and regulatory bodies as well as other healthcare providers. 58,60,69,71,78,93,117 Other studies advocated for public awareness of the primary care roles of community pharmacists, as this would increase demand for such services. 34,46,48,54,62,71,72,75,108,110,110 Another nineteen studies recommended enacting policies that would empower community pharmacists to be seen as healthcare providers, especially in the ght against COVID-19.…”