"Phardiacare" Program for Improved Medication Adherence and Clinical Outcomes of Type 2 Diabetes Mellitus Patients in Community Health Centers.

Abstract

The role of pharmacists in middle-income countries such as Indonesia is still not optimal. In this study, we developed a program called "Phardiacare", a specific pharmacist-led program for Type 2 diabetes mellitus (T2DM) patients. The objective of this study is to assess the effectiveness of the application of the "Phardiacare" program in improving medication adherence and clinical outcomes in T2DM patients. The study was quasi-experimental, with a pretest-posttest design, and was conducted prospectively from July to October 2019 at the Matraman and Jatinegara District Health Center, Jakarta, Indonesia. The study comprised 33 T2DM patients in an intervention group (IG) who received the "Phardiacare" program and 33 patients in a control group (CG). Assessment was performed of HbA1c, FBG, LDL, HDL, total cholesterol, triglycerides, and blood pressure. HbA1c after intervention in the IG was lower than that of the CG (p <0.05). Intra-group mean differences showed improvement in the clinical parameters of FBG, triglycerides, and diastolic blood pressure in the IG (p <0.05), but not in the CG. Other clinical parameters did not show significant improvement. The results of the multivariate analysis showed that the "Phardiacare" program had a 16 times greater effect in reducing levels of HbA1c in the IG [95% CI 3.995:67.113, p <0.001] compared to the CG, even after controlling for confounding variables. The "Phardiacare" program was effective in improving patient medication adherence by decreasing HbA1c and FBG, but it did not have a significant effect on LDL, HDL, total cholesterol, and systolic blood pressure. Therefore, the implementation of Phardiacare program in the management of chronic diseases, especially T2DM, should be considered.