Quality assessment of patients’ self-monitoring of blood glucose in community pharmacies
Objective: To evaluate diabetes patients’ self-monitoring of blood glucose using a community pharmacy-based quality assurance procedure, to investigate whether the procedure improved the quality of the patient performance of self monitoring of blood glucose, and to examine the opinions of the patients taking part in the study.
Methods: The results of patient blood glucose measurements were compared to the results obtained with HemoCue Glucose 201+ by pharmacy employees in 16 Norwegian community pharmacies. Patient performance was monitored using an eight item checklist. Patients whose blood glucose measurements differed from pharmacy measurements by more than 20% were instructed in the correct use of their glucometer. The patients then re-measured their blood glucose. If the results were still outside the set limits, the control procedure was repeated with a new lot of glucometer strips, and then with a new glucometer. The patients returned for a follow-up visit after three months.
Results: During the first visit, 5% of the 338 patients had measurements that deviated from pharmacy blood glucose values by more than 20% and user errors were observed for 50% of the patients. At the second visit, there was no significant change in the analytical quality of patient measurements, but the percentage of patients who made user errors had decreased to 29% (p < 0.001). Eighty-five percent of the patients reported that they used their blood glucose results to adjust medication, exercise or meals. Fifty-one percent of the patients reported a greater trust in their measurements after the second visit. Eighty percent of patients wished to have their measurements assessed yearly. Of these patients, 83% preferred to have the assessment done at the community pharmacy.
Conclusion: A community pharmacy-based quality assessment procedure of patients’ self monitoring of blood glucose significantly reduced the number of user errors. The analytical quality of the patients’ measurements was good and did not improve further during the study. The high analytical quality might be explained by a selection bias of participating patients. Patients also reported increased confidence in their blood glucose measurements after their measurements had been assessed at the pharmacy.
2. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2002;48(3):436-472.
3. Austin MM, Haas L, Johnson T, Parkin CG, Parkin CL, Spollett G, Volpone MT. Self-monitoring of blood glucose: Benefits and utilization. Diabetes Educ. 2006;32(6):835-847.
4. Bergenstal RM, Gavin JR, III. The role of self-monitoring of blood glucose in the care of people with diabetes: report of a global consensus conference. Am J Med. 2005;118(Suppl 9A):1S-6S.
5. Foster SA, Goode JV, Small RE. Home blood glucose monitoring. Ann Pharmacother. 1999;33(3):355-363.
6. Rheney CC, Kirk JK. Performance of three blood glucose meters. Ann Pharmacother. 2000;34(3):317-321.
7. Ho SS, Nakahiro RK, Okamoto MP. Comparison of two brands of test strips for self-monitoring of blood glucose. Am J Health-Syst Pharm. 1997;54(9):1058-1062.
8. Alto WA, Meyer D, Schneid J, Bryson P, Kindig J. Assuring the accuracy of home glucose monitoring. J Am Board Fam Pract. 2002;15(1):1-6.
9. Bergenstal R, Pearson J, Cembrowski GS, Bina D, Davidson J, List S. Identifying variables associated with inaccurate self-monitoring of blood glucose: proposed guidelines to improve accuracy. Diabetes Educ. 2000;26(6):981-989.
10. Kristensen GBB, Nerhus K, Skeie S, Sandberg S. Quality Assurance of Self-monitoring of Blood Glucose at the General Practitioner's Office. Point of Care. 2006;5(3):100-104.
11. Skeie S, Thue G, Nerhus K, Sandberg S. Instruments for self-monitoring of blood glucose: Comparisons of testing quality achieved by patients and a technician. Clin Chem. 2002;48(7):994-1003.
12. Eye KL, Janney L. Identification of need for education in self-monitoring of blood glucose. Am J Health-Syst Pharm. 1996;53(12):1456-1457.
13. Nettles A. User error in blood glucose monitoring. The National Steering Committee for Quality Assurance Report. Diabetes Care. 1993;16(6):946-948.
14. Müller U, Hämmerlein A, Casper A, Schulz M. Community pharmacy-based intervention to improve self-monitoring of blood glucose in type 2 diabetic patients. Pharm Pract (Internet). 2006;4(4):195-203.
15. Barlow I, Beer S, Summerton N. Meta-analysis of diabetes care in general practice. All glucose meters must be subject to formal quality control measures. BMJ. 1999;318(7181):460.
16. Kristensen GB, Christensen NG, Thue G, Sandberg S. Between-lot variation in external quality assessment of glucose: clinical importance and effect on participant performance evaluation. Clin Chem. 2005;51(9):1632-1636.
17. Johnson RN, Baker JR. Error detection and measurement in glucose monitors. Clin Chim Acta. 2001;307(1-2):61-67.
18. Storimans MJ, Klungel OH, Talsma H, Bouvy ML, de Blaey CJ. Collaborative services among community pharmacies for patients with diabetes. Ann Pharmacother. 2005;39(10):1647-1653.
19. Price CP. Point of care testing. BMJ 2001;322(7297):1285-1288.
20. Kristensen GBB, Nerhus K, Thue G, Sandberg S. Standardized evaluation of instruments for self-monitoring of blood glucose by patients and a technologist. Clin Chem. 2004;50(6):1068-1071.
21. ISO. In vitro diagnostic test systems - requirements for blood glucose monitoring systems for self-testing in managing diabetes mellitus. ISO/TC 212/SC. International Standard ISO 15197, 2003. International Standard ISO 15197 ed. Geneva, Switzerland.: 2003.
22. Kjome RLS, Nerhus K, Sandberg S. Implementation of a method for glucose measurements in community pharmacies. Int J Pharm Pract. 2010;18(1):13-19.
23. Davis CE. The effect of regression to the mean in epidemiologic and clinical studies. Am J Epidemiol. 1976;104(5):493-498.
24. Kristensen GB, Monsen G, Skeie S, Sandberg S. Standardized evaluation of nine instruments for self-monitoring of blood glucose. Diabetes Technol Ther. 2008;10(6):467-477.
25. Kjome RL, Sandberg S, Granas AG. Diabetes care in Norwegian pharmacies: a descriptive study. Pharm World Sci 2008;30(2):191-198.
26. The Norwegian Pharmacy Association [homepage on the internet]. Bransjestatistikk [Trade statistics]. http://www.apotek.no/graphics/NAF-bibliotek/Statistikk/apolegemidl09.pdf (accessed September 1st 2009) [in Norwegian].
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.