Pharmacist clinical diabetic patient review

Abstract

The accessibility of community pharmacists puts them in a strategic position to support and empower patients in managing and reducing risks associated with diabetes. The aims of the research were to develop and validate a toolkit for community pharmacist led diabetic patient review, implement the toolkit, and evaluate pharmacist interventions. The methodology involved development of a community pharmacist-led diabetic patient review toolkit in English and Maltese. The toolkit was validated by an interprofessional panel consisting of six members. Sixty diabetic patients registered with a private community pharmacy and taking at least one antidiabetic medication were invited to participate in the study. At baseline (t0), chronic and non-prescription medications were compiled prior to the first session (t1) with the patient, and any pharmaceutical care issues were identified and documented as patient needs. During t1, the pharmacist assessed medications, diabetic knowledge, medication adherence, diabetic complications, lifestyle, laboratory investigations, and monitoring using the devised toolkit. An individualised pharmaceutical care plan was developed for each patient, and an intervention was proposed for each identified need. Follow-up was conducted after one month (t2) to assess patient improvement and actioning of the care plan by the patient. Fifty-five patients attended at t1; male (n=29), mean age 61 (range 24-92) years, diabetes type 2 (n=41), mean number of medications per patient 5 (range 1-11), 2 of which were antidiabetic drugs (range 1-4). Metformin was the most common antidiabetic medication used in 36 patients. Mean duration for t1 was 15 minutes (range 10-25) and 3 minutes (range 2-7) for t2. A total of 160 needs were identified in 50 patients; education-related in all 50 patients and drug-related in 18 patients. Patients required education regarding medication use, adherence, and storage (n=28), lifestyle modifications (n=26), and monitoring (n=23). Drug-related problems concerned inappropriate drug selection (n=10), inappropriate dose selection (n=9), followed by inappropriate medicine handling by the patient (n=6). Referral to a general practitioner was needed for 9 patients. Fifty-three patients attended the follow-up session (t2). At t2, 104 (65%) needs were found to have been addressed by the patient. Implementation rate of education-related interventions was highest (100%) for adherence to medication, appropriate use of glucagon, diet/nutrition, blood glucose and blood pressure self-monitoring, foot check-ups at home and regular blood tests. Implementation rate of drug related interventions was highest with respect to appropriateness in dose selection (89%), followed by patient medication handling (83%). A limitation of the study was patient self-reporting. Community pharmacist interventions were successful in improving patient awareness and led to behavioural changes. The devised toolkit is feasible, practical, strengthens pharmacist-patient relationship, and supports patient empowerment.