The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study
Main Article Content
Keywords
Diabetes Mellitus, Type 2, Medication Therapy Management, Medication Adherence, Pharmacists, Treatment Outcome, Patient Education as Topic, Ethiopia
Abstract
Background: Poor adherence to antidiabetic medications leads to a higher rate of hospital admissions and adverse health outcomes in type 2 diabetes mellitus patients.
Objective: This study aims to evaluate whether a pharmacist-led medication therapy management, compared to the usual care, could enhance medication adherence and reduce hospital admission in patients with type 2 diabetes mellitus.
Methods: A prospective randomized controlled study was conducted in patients with type 2 diabetes mellitus from February 1 to July 30, 2016. Patients in the control group (n=65) received the usual care while patients in the intervention group (n=62) received a personalized pharmacotherapeutic care plan and diabetes education. The two groups were compared by repeated measure ANOVA at 3 and 6‐months with medication adherence (using Morisky medication adherence scale) and number of hospital admissions as the main outcome variables.
Results: A total of 127 patients were included in the study. A marked and statistically significant increase in medication adherence from baseline to 3 and 6 months were noted in the intervention group (increased from 9.2% at baseline to 61% at 6 month) compared with the control group (increased from 13.2% at baseline (to 30.2% at 6 month; p-value<0.01). Furthermore, at the 6-month follow-up, only 23 patients in MTM group with poorly controlled blood glucose levels resulted in hospital admissions compared to 48 patients in non-MTM group, resulting in a 52.1% fewer hospital admissions (p< 0.001).
Conclusions: The findings of this study implied that pharmacist-led medication therapy management might improve medication adherence and reduce number of hospitalizations in patients with type 2 diabetes mellitus. Hence, policies and guidelines should be in place in order for clinical pharmacists to fully engage in patient care and improve the medication therapy outcomes.
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References
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19. Mekonnen AB, Yesuf EA, Odegard PS, Wega SS. Implementing ward based clinical pharmacy services in an Ethiopian University Hospital. Pharm Pract (Granada). 2013;11(1):51-57. doi: 10.4321/s1886-36552013000100009
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22. Morisky DE, Ang A, Krousel‐Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-354.
23. Krousel-Wood M, Islam T, Webber LS, Re RN, Morisky DE, Muntner P. New medication adherence scale versus pharmacy fill rates in seniors with hypertension. Am J Manag Care. 2009;15(1):59-66.
24. Bruce SP, Acheampong F, Kretchy I. Adherence to oral anti-diabetic drugs among patients attending a Ghanaian teaching hospital. Pharm Pract (Granada). 2015;13(1):533. doi: 10.18549/pharmpract.2015.01.533
25. Shah A. “Pharmacy Intervention in the Medication Use Process: The Role of Pharmacists in Improving Patient Safety.” University of Manitoba, Winnipeg, Canada; 2010.
26. Abebe SM, Berhane Y, Worku A. Barriers to diabetes medication adherence in North West Ethiopia. Springerplus. 2014;3:195. doi: 10.1186/2193-1801-3-195
27. Seligman HK, Jacobs EA, Lopez A, Tschann J, Fernandez A. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care. 2012;35(2):233-238. doi: 10.2337/dc11-1627
28. Ho PM, Bryson CL, Romfield JS. Medication adherence; its importance in cardiovascular outcome. Circulation. 2009;119(23):3028-3035. doi: 10.1161/CIRCULATIONAHA.108.768986
29. Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med. 2007;167(6):540-550. doi: 10.1001/archinte.167.6.540
30. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006;296(21):2563-2571. doi: 10.1001/jama.296.21.joc60162
31. Donnelly LA, Morris AD, Evans JM; DARTS/MEMO Collaboration. Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes. QJM. 2007;100(6):345-350. doi: 10.1093/qjmed/hcm031
32. Cutrona SL, Choudhry NK, Fischer MA, Servi A, Liberman JN, Brennan TA, Shrank WH. Modes of delivery for interventions to improve cardiovascular medication adherence: Review. Am J Manag Care. 2010;16(12):929-942.
33. Adepu R, Ari SM. Influence of structured patient education on therapeutic outcomes in diabetes and hypertensive patients. Asian J Pharm Clin Res. 2010;3(3):174-178.
34. Xin C, Xia Z, Jiang C, Lin M, Li G. Effect of pharmaceutical care on medication adherence of patients newly prescribed insulin therapy: a randomized controlled study. Patient Prefer Adherence. 2015;9:797-802. doi: 10.2147/PPA.S84411
35. Antoine SL, Pieper D, Mathes T, Eikermann M. Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials. BMC Endocr Disord. 2014;14:53. doi: 10.1186/1472-6823-14-53
36. Gordois A, Shuffham P, Shaerer A, Oglesby A. The health care costs of diabetic nephropathy in the United States and the United Kingdom. J Diabetes Complications. 2004;18(1):18-26. doi: 10.1016/S1056-8727(03)00035-7
37. Doneva M, Valov V, Borisova A-M, Tankova T, Savova A, Manova M, Czech M, Petrova G. Comparative analysis of the cost of insulin treated patients in Bulgaria. Biotechnol Biotechnol Equip. 2013;27(2):3748-3752. doi: 10.5504/BBEQ.2013.0001
2. IDF Diabetes Atlas, Seventh Ed. 2015. Accessed at www.diabetesatlas.org (accessed 1 Aug 2017).
3. Nshisso LD, Reese A, Gelaye B, Lemma S, Berhane Y, Williams MA. Prevalence of hypertension and diabetes among Ethiopian adults. Diabetes Metab Syndr. 2012;6(1):36-41. doi: 10.1016/j.dsx.2012.05.005
4. Venkartesan R, Devi AS, Parasuraman S, Sriram S. Role of community pharmacist in improving knowledge and glycemic control of type 2 diabetes. Perspect Clin Res. 2012;3(1):26-31. doi: 10.4103/2229-3485.92304
5. O’Loughlin J, Masson P, Déry V, Fagnan D. The role of community pharmacists in health education and disease prevention: a survey of their interests and needs in relation to cardiovascular disease. Prev Med. 1999;28(3):324-331. doi: 10.1006/pmed.1998.0436
6. Paes AHP, Bakker A, Soe-Agnie CJ. Impact of dosage frequency in patient compliance. Diabetes Care. 1997;20(10):1512-1517.
7. Lindenmeyer A, Hearnshaw H, Vermeire E, Van Royen P, Wens J, Biot Y. Interventions to improve adherence to medication in people with type 2 diabetes mellitus: a review of the literature on the role of pharmacists. J Clin Pharm Ther. 2006;31(5):409-419. doi: 10.1111/j.1365-2710.2006.00759.x
8. World Health Organization. 2003. Adherence to long‐term therapies: evidence for action. Geneva: WHO. www.who.int/chp/knowledge/publications/adherence_report/en/ (accessed 1 Aug 2017).
9. World Health Organization. The Pursuit of Responsible Use of Medicines: Sharing and Learning from Country Experiences. Geneva: WHO; 2012.
10. Yarnall KSH, Østbye T, Krause KM, Pollak KI, Gradison M, Michener JL. Family Physicians as Team Leaders: ‘Time’ to Share the Care. Preventing Chronic Disease 6 (2): A59. www.cdc.gov/pcd/issues/2009/apr/08_0023.htm (accessed 1 Aug 2017).
11. Dent LA, Harris KJ, Noonan CW: Randomized trial assessing the effectiveness of a pharmacist-delivered program for smoking cessation. Ann Pharmacother. 2009;43(2):194-201. doi: 10.1345/aph.1L556
12. Gerber RA, Liu G, Mccombs JS. Impact of pharmacist consultations provided to patients with diabetes on healthcare costs in a health maintenance organization. Am J Manag Care. 1998;4(7):991-1000.
13. Bajorek B, LeMay KS, Magin P, Roberts C, Krass I, Armour CL. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges. Pharm Pract (Granada). 2016;14(2):723. doi: 10.18549/PharmPract.2016.02.723
14. Irons BK, Meyerrose G, Laguardia S, Hazel K, Seifert CF. A collaborative cardiologist-pharmacist care model to improve hypertension management in patients with or at high risk for cardiovascular disease. Pharm Pract (Granada). 2012;10(1):25-32. doi: 10.4321/s1886-36552012000100005
15. Bluml BM. Definition of medication therapy management: development of profession wide consensus. J Am Pharm Assoc (2003). 2005;45(5):566-572.
16. Sisson E, Kuhn C. Pharmacist roles in the management of patients with type 2 diabetes. J Am Pharm Assoc (2003). 2009;49(Suppl 1):S41-S45. doi: 10.1331/JAPhA.2009.09075
17. Skowron A, Polak S, Brandys J. The impact of pharmaceutical care on patients with hypertension and their pharmacists. Pharm Pract (Granada). 2011;9(2):110-115. doi: 10.4321/s1886-36552011000200009
18. Jennings DL, Ragucci KR, Chumney ECG, Wessell AM. Impact of clinical pharmacist intervention on diabetes related quality-of-life in an ambulatory care clinic. Pharm Pract (Granada). 2007;5(4):169-173. doi: 10.4321/s1886-36552007000400005
19. Mekonnen AB, Yesuf EA, Odegard PS, Wega SS. Implementing ward based clinical pharmacy services in an Ethiopian University Hospital. Pharm Pract (Granada). 2013;11(1):51-57. doi: 10.4321/s1886-36552013000100009
20. Geremew E, Worku F, Tadeg H, Ejigu E, Mekonnen N. Building Local Capacity for Clinical Pharmacy Service in Ethiopia through a Holistic In-Service Training Approach. Submitted to the US Agency for International Development by the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program. Arlington, VA: Management Sciences for Health; 2014.
21. Krousel‐Wood MA, Muntner P, Islam T, Morisky DE, Webber LS. Barriers to and determinants of medication adherence in hypertension management: perspective of the cohort study of medication adherence among older adults. Med Clin North Am. 2009;93(3):753-769. doi: 10.1016/j.mcna.2009.02.007
22. Morisky DE, Ang A, Krousel‐Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-354.
23. Krousel-Wood M, Islam T, Webber LS, Re RN, Morisky DE, Muntner P. New medication adherence scale versus pharmacy fill rates in seniors with hypertension. Am J Manag Care. 2009;15(1):59-66.
24. Bruce SP, Acheampong F, Kretchy I. Adherence to oral anti-diabetic drugs among patients attending a Ghanaian teaching hospital. Pharm Pract (Granada). 2015;13(1):533. doi: 10.18549/pharmpract.2015.01.533
25. Shah A. “Pharmacy Intervention in the Medication Use Process: The Role of Pharmacists in Improving Patient Safety.” University of Manitoba, Winnipeg, Canada; 2010.
26. Abebe SM, Berhane Y, Worku A. Barriers to diabetes medication adherence in North West Ethiopia. Springerplus. 2014;3:195. doi: 10.1186/2193-1801-3-195
27. Seligman HK, Jacobs EA, Lopez A, Tschann J, Fernandez A. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care. 2012;35(2):233-238. doi: 10.2337/dc11-1627
28. Ho PM, Bryson CL, Romfield JS. Medication adherence; its importance in cardiovascular outcome. Circulation. 2009;119(23):3028-3035. doi: 10.1161/CIRCULATIONAHA.108.768986
29. Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med. 2007;167(6):540-550. doi: 10.1001/archinte.167.6.540
30. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low density lipoprotein cholesterol: a randomized controlled trial. JAMA. 2006;296(21):2563-2571. doi: 10.1001/jama.296.21.joc60162
31. Donnelly LA, Morris AD, Evans JM; DARTS/MEMO Collaboration. Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes. QJM. 2007;100(6):345-350. doi: 10.1093/qjmed/hcm031
32. Cutrona SL, Choudhry NK, Fischer MA, Servi A, Liberman JN, Brennan TA, Shrank WH. Modes of delivery for interventions to improve cardiovascular medication adherence: Review. Am J Manag Care. 2010;16(12):929-942.
33. Adepu R, Ari SM. Influence of structured patient education on therapeutic outcomes in diabetes and hypertensive patients. Asian J Pharm Clin Res. 2010;3(3):174-178.
34. Xin C, Xia Z, Jiang C, Lin M, Li G. Effect of pharmaceutical care on medication adherence of patients newly prescribed insulin therapy: a randomized controlled study. Patient Prefer Adherence. 2015;9:797-802. doi: 10.2147/PPA.S84411
35. Antoine SL, Pieper D, Mathes T, Eikermann M. Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials. BMC Endocr Disord. 2014;14:53. doi: 10.1186/1472-6823-14-53
36. Gordois A, Shuffham P, Shaerer A, Oglesby A. The health care costs of diabetic nephropathy in the United States and the United Kingdom. J Diabetes Complications. 2004;18(1):18-26. doi: 10.1016/S1056-8727(03)00035-7
37. Doneva M, Valov V, Borisova A-M, Tankova T, Savova A, Manova M, Czech M, Petrova G. Comparative analysis of the cost of insulin treated patients in Bulgaria. Biotechnol Biotechnol Equip. 2013;27(2):3748-3752. doi: 10.5504/BBEQ.2013.0001
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Sep 3, 2017
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Erku DA, Ayele AA, Mekuria AB, Belachew SA, Hailemeskel B, Tegegn HG. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study. Pharm Pract (Granada) [Internet]. 2017 Sep. 3 [cited 2023 Mar. 27];15(3):1026. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/1026
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Author Biographies
Daniel A. Erku
Department of clinical pharmacyy, Lecturer