Impact of Pharmacist-Led Diabetes Program on Glycated Hemoglobin and Diabetes-Related Hospitalizations in a District-Level Hospital: A Pilot Retrospective Cohort Study
Abstract
Purpose: The purpose of this study is to evaluate the effectiveness of pharmacist-led diabetes program in improving glycated hemoglobin and diabetes-related hospitalizations of patients with type 2 diabetes mellitus in a district level hospital without structured diabetes care model. Thus far, the impact of pharmacist-led diabetes program in hospital settings without endocrinologist, dietitian, nutritionist, diabetes educator and diabetes link nurse is unknown. This study hypothesized that there would be a difference in the aforementioned outcomes among patients with type 2 diabetes mellitus managed primarily by pharmacist.
Methods: A pilot retrospective cohort study was conducted among patients with type 2 diabetes mellitus attending regular follow-up in the medical outpatient department and diabetes medication therapy adherence clinic. Convenience sampling method was used to recruit study subjects who were diagnosed with type 2 diabetes mellitus, aged ≥18 years old and A1C ≥8%.
Results: Twenty-nine study subjects were eligible for both groups respectively. Pharmacist group had study subjects with higher baseline A1C values, more dyslipidemia cases and all prescribed with insulin therapy. A significant mean A1C reductions from the baseline to twelve months after enrollment could be observed in the pharmacist program but not in the usual medical care group. However, there was no significant difference between these two groups in terms of diabetes-related hospitalizations. Conclusion: Pharmacist-led diabetes program has a significant impact on glycated hemoglobin reductions among patients with type 2 diabetes mellitus but not diabetes-related hospitalizations.
Keywords:
Pharmacist, Diabetes, Glycated hemoglobin, Hospitalization
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References
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American Diabetes Association. (2013). Economic costs of diabetes in the US in 2012, Diabetes Care. 36(4), 1033-46.
Butt, M., Ali, A.M., Bakry, M.M., & Mustafa, N. (2016). Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: A randomised controlled study, Saudi Pharmaceutical Journal. 24(1), 40-8.
Castejón, A.M., Calderón, J.L., Perez, A., Millar, C., McLaughlin-Middlekauff, J., Sangasubana, N., Alvarez, G., Arce, L., Hardigan, P., & Rabionet, S.E. (2013). A community-based pilot study of a diabetes pharmacist intervention in Latinos: Impact on weight and hemoglobin A1c, Journal of Health Care for the Poor and Underserved. 24(4), 48-60.
Chung, N., Rascati, K., Lopez, D., Jokerst, J., & Garza, A. (2014). Impact of a clinical pharmacy program on changes in hemoglobin A1c, diabetes-related hospitalizations, and diabetes-related emergency department visits for patients with diabetes in an underserved population, Journal of Managed Care Pharmacy. 20(9), 914-9.
Cohen, L.B., Taveira, T.H., Khatana, S.A.M., Dooley, A.G., Pirraglia, P.A., & Wu, W.C. (2011). Pharmacist-led shared medical appointments for multiple cardiovascular risk reduction in patients with type 2 diabetes, The Diabetes Educator. 37(6), 801-12.
Department of Biostatistics, 2009. PS: Power and sample size calculation version 3.0. Software. Nashville: Vanderbilt University.
Dugdale, D.C., Epstein, R., & Pantilat, S.Z. (1999). Time and the patient–physician relationship, Journal of General Internal Medicine. 14(S1), 34-40.
Farsaei, S., Sabzghabaee, A.M., Zargarzadeh, A.H., & Amini, M. (2011). Effect of pharmacist-led patient education on glycemic control of type 2 diabetics: A randomized controlled trial, Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences. 16(1), 43.
International Living, 2017. 4 Countries with the best healthcare in the world. Baltimore, MD: International Living, viewed 14 June 2017, from: https://internationalliving.com/2017/01/4-countries-best-healthcare-world/
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Jacobs, M., Sherry, P.S., Taylor, L.M., Amato, M., Tataronis, G.R., & Cushing, G. (2012). Pharmacist assisted medication program enhancing the regulation of diabetes (PAMPERED) study, Journal of the American Pharmacists Association. 52(5), 613-21.
Kelly, C., & Rodgers, P.T. (2000). Implementation and evaluation of a pharmacist-managed diabetes service, Journal of Managed Care Pharmacy. 6(6), 488-93.
Kelly, T.N., Bazzano, L.A., Fonseca, V.A., Thethi, T.K., Reynolds, K., & He, J. (2009). Systematic review: Glucose control and cardiovascular disease in type 2 diabetes, Annals of Internal Medicine. 151(6), 394-403.
Krass, I., Armour, C.L., Mitchell, B., Brillant, M., Dienaar, R., Hughes, J., Lau, P., Peterson, G., Stewart, K., Taylor, S., & Wilkinson, J. (2007). The Pharmacy diabetes care program: Assessment of a community pharmacy diabetes service model in Australia, Diabetic Medicine. 24(6), 677-83.
Kumar, L.N., Chin, S.T., Rachet, T., Lim, K.Y., & Fudziah, A. (2011). Clinical and economic impact of pharmacist-run medication therapy adherence clinic service on patients with type 2 diabetes, Malaysian Journal of Public Health Medicine. 5(11), 42.
Ladhani, N.N., Majumdar, S.R., Johnson, J.A., Tsuyuki, R.T., Lewanczuk, R.Z., Spooner, R., & Simpson, S.H. (2012). Adding pharmacists to primary care teams reduces predicted long‐term risk of cardiovascular events in Type 2 diabetic patients without established cardiovascular disease: Results from a randomized trial, Diabetic Medicine. 29(11), 1433-9.
Letchuman, G.R., Wan Nazaimoon, W.M., Wan Mohamad, W.B., Chandran, L.R., Tee, G.H., Jamaiyah, H., Isa, M.R., Zanariah, H., Fatanah, I., & Ahmad Faudzi, Y. (2010). Prevalence of diabetes in the Malaysian national health morbidity survey III 2006, Medical Journal of Malaysia. 65(3), 180-6.
Lim, P.C., & Lim, K. (2010). Evaluation of a pharmacist-managed diabetes medication therapy adherence clinic, Pharmacy Practice. 8(4), 250.
Lim, P.C., Lim, K., Embee, Z.C., Hassali, M.A., Thiagarajan, A., & Khan, T.M. (2016). Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia, Pakistan Journal of Pharmaceutical Sciences. 29(2).
Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., Abraham, J., Adair, T., Aggarwal, R., Ahn, S.Y., & AlMazroa, M.A. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010, The Lancet. 380(9859), 2095-128.
Menzin, J., Korn, J.R., Cohen, J., Lobo, F., Zhang, B., Friedman, M., & Newmann, P.J. (2010). Relationship between glycemic control and diabetes-related hospital costs in patients with type 1 or type 2 diabetes mellitus, Journal of Managed Care Pharmacy. 16(4), 264-75.
Morello, C.M., Christopher, M.L., Ortega, L., Khoan, J., Rotunno, T., Edelman, S.V., Henry, R.R., & Hirsch, J.D. (2016). Clinical outcomes associated with a collaborative pharmacist-endocrinologist diabetes intense medical management “tune up” clinic in complex patients, Annals of Pharmacotherapy. 50(1), 8-16.
NCD Risk Factor Collaboration. (2016). Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4•4 million participants, The Lancet. 387(10027), 1513-30.
Pepper, M.J., Mallory, N., Coker, T.N., Chaki, A., & Sando, K.R. (2012). Pharmacists’ impact on improving outcomes in patients with type 2 diabetes mellitus, The Diabetes Educator. 38(3), 409-16.
Pharmaceutical Services Division. (2014). The cost of diabetes care for ambulatory patients in Malaysian ministry of health facilities. Malaysia.
Png, M.E., Yoong, J., Phan, T.P., & Wee, H.L. (2016). Current and future economic burden of diabetes among working-age adults in Asia: Conservative estimates for Singapore from 2010-2050, BMC public health. 16(1), 153.
Ray, K.K., Seshasai, S.R.K., Wijesuriya, S., Sivakumaran, R., Nethercott, S., Preiss, D., Erqou, S., & Sattar, N. (2009). Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: A meta-analysis of randomised controlled trials, The Lancet. 373(9677), 1765-72.
Rothman, R.L., Malone, R., Bryant, B., Shintani, A.K., Crigler, B., Dewalt, D.A., Dittus, R.S., Weinberger, M., & Pignone, M.P. (2005). A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes, The American Journal of Medicine. 118(3), 276-84.
Samtia, A.M., Rasool, M.F., Ranjha, N.M., Usman, F., & Javed, I. (2013). A multifactorial intervention to enhance adherence to medications and disease-related knowledge in type 2 diabetic patients in Southern Punjab, Pakistan, Tropical Journal of Pharmaceutical Research. 12(5), 851-6.
Seuring, T., Archangelidi, O., & Suhrcke, M. (2015). The economic costs of type 2 diabetes: A global systematic review, Pharmacoeconomics. 33(8), 811-31.
Taveira, T.H., Friedmann, P.D., Cohen, L.B., Dooley, A.G., Khatana, S.A.M., Pirraglia, P.A., & Wu, W.C. (2010). Pharmacist-led group medical appointment model in type 2 diabetes, The Diabetes Educator. 36(1), 109-17.
UK Prospective Diabetes Study (UKPDS) Group. (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33), The Lancet. 352(9131), 837-53.
World Health Organization. (2016). Global report on diabetes. World Health Organization.
Yesudian, C.A., Grepstad, M., Visintin, E., & Ferrario, A. (2014). The economic burden of diabetes in India: a review of the literature, Globalization and health. 10(1), 80.
You, L.X., Selvadurai, S., Yee, C.K., Noh, N.B., Bao, G.C., Joyce, T., Hamdi, A.H., & Haron, N. (2015). Impact of pharmacist-managed diabetes medication therapy adherence clinic (DMTAC) in government health clinics, Malaysian Journal of Pharmaceutical Sciences. 13(1), 43.
ADVANCE Collaborative Group. (2008). Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes, New England Journal of Medicine. 358(24), 2560-72.
American Diabetes Association. (2013). Economic costs of diabetes in the US in 2012, Diabetes Care. 36(4), 1033-46.
Butt, M., Ali, A.M., Bakry, M.M., & Mustafa, N. (2016). Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: A randomised controlled study, Saudi Pharmaceutical Journal. 24(1), 40-8.
Castejón, A.M., Calderón, J.L., Perez, A., Millar, C., McLaughlin-Middlekauff, J., Sangasubana, N., Alvarez, G., Arce, L., Hardigan, P., & Rabionet, S.E. (2013). A community-based pilot study of a diabetes pharmacist intervention in Latinos: Impact on weight and hemoglobin A1c, Journal of Health Care for the Poor and Underserved. 24(4), 48-60.
Chung, N., Rascati, K., Lopez, D., Jokerst, J., & Garza, A. (2014). Impact of a clinical pharmacy program on changes in hemoglobin A1c, diabetes-related hospitalizations, and diabetes-related emergency department visits for patients with diabetes in an underserved population, Journal of Managed Care Pharmacy. 20(9), 914-9.
Cohen, L.B., Taveira, T.H., Khatana, S.A.M., Dooley, A.G., Pirraglia, P.A., & Wu, W.C. (2011). Pharmacist-led shared medical appointments for multiple cardiovascular risk reduction in patients with type 2 diabetes, The Diabetes Educator. 37(6), 801-12.
Department of Biostatistics, 2009. PS: Power and sample size calculation version 3.0. Software. Nashville: Vanderbilt University.
Dugdale, D.C., Epstein, R., & Pantilat, S.Z. (1999). Time and the patient–physician relationship, Journal of General Internal Medicine. 14(S1), 34-40.
Farsaei, S., Sabzghabaee, A.M., Zargarzadeh, A.H., & Amini, M. (2011). Effect of pharmacist-led patient education on glycemic control of type 2 diabetics: A randomized controlled trial, Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences. 16(1), 43.
International Living, 2017. 4 Countries with the best healthcare in the world. Baltimore, MD: International Living, viewed 14 June 2017, from: https://internationalliving.com/2017/01/4-countries-best-healthcare-world/
Institute for Public Health, 2015a. National health and morbidity survey 2011 (NHMS 2011) volume II: Non-communicable diseases. Kuala Lumpur, viewed 14 June 2017 from: http://www.iku.gov.my/index.php/research-eng/list-of-research-eng/iku-eng/nhms-eng/nhms-2011-eng
Institute for Public Health, 2015b. National health and morbidity survey 2015 (NHMS 2015) volume II: Non-communicable diseases, risk factors & other health problems. Kuala Lumpur: Institute for Public Health, viewed 14 June 2017 from: http://www.iku.gov.my/index.php/ research-eng/list-of-research-eng/iku-eng/ nhms-eng/nhms-2015
Jacobs, M., Sherry, P.S., Taylor, L.M., Amato, M., Tataronis, G.R., & Cushing, G. (2012). Pharmacist assisted medication program enhancing the regulation of diabetes (PAMPERED) study, Journal of the American Pharmacists Association. 52(5), 613-21.
Kelly, C., & Rodgers, P.T. (2000). Implementation and evaluation of a pharmacist-managed diabetes service, Journal of Managed Care Pharmacy. 6(6), 488-93.
Kelly, T.N., Bazzano, L.A., Fonseca, V.A., Thethi, T.K., Reynolds, K., & He, J. (2009). Systematic review: Glucose control and cardiovascular disease in type 2 diabetes, Annals of Internal Medicine. 151(6), 394-403.
Krass, I., Armour, C.L., Mitchell, B., Brillant, M., Dienaar, R., Hughes, J., Lau, P., Peterson, G., Stewart, K., Taylor, S., & Wilkinson, J. (2007). The Pharmacy diabetes care program: Assessment of a community pharmacy diabetes service model in Australia, Diabetic Medicine. 24(6), 677-83.
Kumar, L.N., Chin, S.T., Rachet, T., Lim, K.Y., & Fudziah, A. (2011). Clinical and economic impact of pharmacist-run medication therapy adherence clinic service on patients with type 2 diabetes, Malaysian Journal of Public Health Medicine. 5(11), 42.
Ladhani, N.N., Majumdar, S.R., Johnson, J.A., Tsuyuki, R.T., Lewanczuk, R.Z., Spooner, R., & Simpson, S.H. (2012). Adding pharmacists to primary care teams reduces predicted long‐term risk of cardiovascular events in Type 2 diabetic patients without established cardiovascular disease: Results from a randomized trial, Diabetic Medicine. 29(11), 1433-9.
Letchuman, G.R., Wan Nazaimoon, W.M., Wan Mohamad, W.B., Chandran, L.R., Tee, G.H., Jamaiyah, H., Isa, M.R., Zanariah, H., Fatanah, I., & Ahmad Faudzi, Y. (2010). Prevalence of diabetes in the Malaysian national health morbidity survey III 2006, Medical Journal of Malaysia. 65(3), 180-6.
Lim, P.C., & Lim, K. (2010). Evaluation of a pharmacist-managed diabetes medication therapy adherence clinic, Pharmacy Practice. 8(4), 250.
Lim, P.C., Lim, K., Embee, Z.C., Hassali, M.A., Thiagarajan, A., & Khan, T.M. (2016). Study investigating the impact of pharmacist involvement on the outcomes of diabetes medication therapy adherence program Malaysia, Pakistan Journal of Pharmaceutical Sciences. 29(2).
Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., Abraham, J., Adair, T., Aggarwal, R., Ahn, S.Y., & AlMazroa, M.A. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010, The Lancet. 380(9859), 2095-128.
Menzin, J., Korn, J.R., Cohen, J., Lobo, F., Zhang, B., Friedman, M., & Newmann, P.J. (2010). Relationship between glycemic control and diabetes-related hospital costs in patients with type 1 or type 2 diabetes mellitus, Journal of Managed Care Pharmacy. 16(4), 264-75.
Morello, C.M., Christopher, M.L., Ortega, L., Khoan, J., Rotunno, T., Edelman, S.V., Henry, R.R., & Hirsch, J.D. (2016). Clinical outcomes associated with a collaborative pharmacist-endocrinologist diabetes intense medical management “tune up” clinic in complex patients, Annals of Pharmacotherapy. 50(1), 8-16.
NCD Risk Factor Collaboration. (2016). Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4•4 million participants, The Lancet. 387(10027), 1513-30.
Pepper, M.J., Mallory, N., Coker, T.N., Chaki, A., & Sando, K.R. (2012). Pharmacists’ impact on improving outcomes in patients with type 2 diabetes mellitus, The Diabetes Educator. 38(3), 409-16.
Pharmaceutical Services Division. (2014). The cost of diabetes care for ambulatory patients in Malaysian ministry of health facilities. Malaysia.
Png, M.E., Yoong, J., Phan, T.P., & Wee, H.L. (2016). Current and future economic burden of diabetes among working-age adults in Asia: Conservative estimates for Singapore from 2010-2050, BMC public health. 16(1), 153.
Ray, K.K., Seshasai, S.R.K., Wijesuriya, S., Sivakumaran, R., Nethercott, S., Preiss, D., Erqou, S., & Sattar, N. (2009). Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: A meta-analysis of randomised controlled trials, The Lancet. 373(9677), 1765-72.
Rothman, R.L., Malone, R., Bryant, B., Shintani, A.K., Crigler, B., Dewalt, D.A., Dittus, R.S., Weinberger, M., & Pignone, M.P. (2005). A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes, The American Journal of Medicine. 118(3), 276-84.
Samtia, A.M., Rasool, M.F., Ranjha, N.M., Usman, F., & Javed, I. (2013). A multifactorial intervention to enhance adherence to medications and disease-related knowledge in type 2 diabetic patients in Southern Punjab, Pakistan, Tropical Journal of Pharmaceutical Research. 12(5), 851-6.
Seuring, T., Archangelidi, O., & Suhrcke, M. (2015). The economic costs of type 2 diabetes: A global systematic review, Pharmacoeconomics. 33(8), 811-31.
Taveira, T.H., Friedmann, P.D., Cohen, L.B., Dooley, A.G., Khatana, S.A.M., Pirraglia, P.A., & Wu, W.C. (2010). Pharmacist-led group medical appointment model in type 2 diabetes, The Diabetes Educator. 36(1), 109-17.
UK Prospective Diabetes Study (UKPDS) Group. (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33), The Lancet. 352(9131), 837-53.
World Health Organization. (2016). Global report on diabetes. World Health Organization.
Yesudian, C.A., Grepstad, M., Visintin, E., & Ferrario, A. (2014). The economic burden of diabetes in India: a review of the literature, Globalization and health. 10(1), 80.
You, L.X., Selvadurai, S., Yee, C.K., Noh, N.B., Bao, G.C., Joyce, T., Hamdi, A.H., & Haron, N. (2015). Impact of pharmacist-managed diabetes medication therapy adherence clinic (DMTAC) in government health clinics, Malaysian Journal of Pharmaceutical Sciences. 13(1), 43.
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Lau, B., Ismail, S., Ng, S., & Mohmmad, N. (2018). Impact of Pharmacist-Led Diabetes Program on Glycated Hemoglobin and Diabetes-Related Hospitalizations in a District-Level Hospital: A Pilot Retrospective Cohort Study. International Journal of Advancement in Life Sciences Research, 1(2), 26-36. Retrieved from http://www.ijalsr.org/index.php/journal/article/view/17
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