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
Diabetes Mellitus, Type 2, Medication Therapy Management, Medication Adherence, Pharmacists, Treatment Outcome, Patient Education as Topic, Ethiopia
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.
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