Safe and effective use of medicines for patients with type 2 diabetes - A randomized controlled trial of two interventions delivered by local pharmacies.

Abstract

Poor management of chronic medical treatments may result in severe health consequences for patients as well as costs for society. Non-adherence is common among patients with type 2 diabetes. Interventions by community pharmacists may assist in improving adherence and consequently health outcomes for patients with type 2 diabetes. The study aimed to investigate whether a comprehensive and a brief individually targeted intervention for patients with type 2 diabetes could improve implementation of drug therapy in Danish community pharmacies. The interventions intended to give patients more competence and support to improve adherence and self-management in order to reach treatment goals for diabetes and blood pressure as well as goals for patient perceived outcomes. This study was an RCT, comparing two interventions; basic intervention (BI) and extended intervention (EI). The intervention model sought to identify drug-related problems as well as issues experienced by patients in relation to medicines use, and consequently find individually tailored solutions to address the identified problems. The trial included five pharmacies; five pharmacists and five pharmaconomists, and 205 patients; BI (39 patients), EI (41 patients), Control (125 patients). Patient reported systolic blood pressure improved in both groups and significantly in the EI group compared to the control group (P=0.020). Increase in disease-related knowledge was higher in the EI group compared to the control group (P=0.006), but not in the BI group (P=0.139). Except for quality of life, the EI group reported significantly higher improvement in all aspects of beneficial effects from participating in the trial when compared to the control group. No significant differences were detected for changes in hospital admissions or in doctor visits. The two intervention groups reported significantly higher satisfaction with all aspects of patient satisfaction with pharmacy staff in the project than control patients. The study showed improvement in patient health, well-being, knowledge, and satisfaction as a result of the trial, particularly for the EI group. Thus a program comprising patient narratives, problem and resource identification, and multi-dimensional individually tailored patient medication management solutions seems to be an appropriate intervention to ensure outcome improvement of non-adherent patients.