A Community Pharmacy-Based Intervention in the Matrix of Type 2 Diabetes Mellitus Outcomes (CPBI-T2DM): A Cluster Randomized Controlled Trial

Abstract

Introduction: Egypt has the ninth highest diabetes mellitus (DM) prevalence in the world. There is a growing interest in community involvement in DM management. Aim of the study: The aim of the study was to evaluate the tailored diabetes care model (DCM) implementation in Alexandria governorate by community pharmacy-based intervention (CPBI) from a clinical, humanistic, and economic aspect. Methods: This is a 6-month period cross-over cluster randomized control trial conducted in Alexandria. Ten clusters owing 10 community pharmacies (CPs) recruited 100 health insurance-deprived T2DM patients with >7% HbA1c in 6-months. The study was divided into 2 phases (3 months for each period) with a 1-month washout period in between. After CPs training on DCM, the interventional group received pictorial training for 45 minutes in first visit, and 15 minutes in weekly visits, whereas the control group patients received the usual care (UC). At baseline and end of each phase (3 months), patients had clinical and physical activity assessments, filled all forms of study questionnaire (knowledge, self-management, satisfaction, and adherence) and did all laboratory investigations (Fasting Blood Glucose [FBG]), HbA1c, protein-creatinine clearance (PCR), creatine clearance (GFR), and lipid profile. Results: There was no significant difference in the basal systolic and diastolic blood pressure between patients in the CBPI and UC groups, but the CBPI had significantly decreased the mean SBP and DBP by ( P = .008, .040, respectively). Also, significant waist circumference and BMI reductions (−5.82 cm and −1.86 kg/m2, P = .001) were observed in the CBPI. The CBPI patients achieved a greater reduction in FBG and HbA1C than the UC patients (102 mg/dL and 1.9%, respectively P < .001). Also, significant reductions in total cholesterol, LDL, and triglyceride (−6.4, −15.4, and −6.3 mg/dL respectively, P = .001) were achieved in the CBPI group. No significant differences were found in HDL, GFR, and PCR. Moreover, significant improvements of behavior, score of knowledge, self-management, satisfaction, and adherence were observed in CBPI patients. After multivariate analysis, HbA1C readings were significantly influenced by baseline HbA1C and eating habits. The cost saving for CPBI was −1581 LE per 1% HbA1c reduction. Conclusion: This is the first study in Egypt that illustrated the positive impact of pictorial DCM delivered by CPBI collaborative care on clinical, humanistic, laboratory, and economic outcomes to local T2DM patients.

Pharmacists’ involvement in physical activity promotion in community pharmacy: a systematic review

“…Six studies were from Australia, 14 , 19 , 29 , 33 , 36 , 39 and five from the USA. 15 , 24 , 27 , 31 , 34 We found two studies in the UK, 25 , 26 Egypt 16 , 18 and Thailand. 35 , 37 All the remaining studies were from different countries: Canada, 13 France, 17 Germany, 21 Ghana, 28 Greece, 32 Iran, 20 Italy, 40 Japan, 38 Nigeria, 23 Norway, 22 Turkey 30 and Spain.…”

“…The study by Farag Mohamed et al 16 focused on an educational component comprising pictorial posters of diabetes mellitus and its complications and a non-pharmacological component in the form of lifestyle changes, including physical exercise, which consisted of walking at least three times weekly for 30 min. Exposure to intervention did not significantly increase PA from light or no PA to moderate activity (23.6% for control vs. 45.0% for intervention).…”

“…Almost all studies used self-reported measures for PA measurement, such as a percentage of patients who met a PA recommendation (e.g. 55% of participants reached 50 min/week), such as the study by Farag Mohamed 16 where exposure to intervention increased participants’ PA levels from light or no PA to moderate activity. Self-reported outcomes might not provide a solid reference for policymakers and other stakeholders on the value of the intervention and are subject to reporting bias, leading to disparities between self-reported and objective outcomes.…”

Primary Health Care: Roles of Community Pharmacists in Low- and Middle-Income Countries—A Systematic Review

“…46,69,72,109 Another ve studies described medication reviews and follow-up for patients with chronic diseases. 45,71,74,93,114 Thirteen studies outlined self-care and point-of-care testing as well as medication adherence in patients with type 2 diabetes, 33,34,37,53,57,64,66,68,84,91,96,108,110 while patient counselling, identi cation and resolution of medication-related problems in patients with type 2 diabetes mellitus were identi ed in two other studies. 115,116 Asthma self-management was reported in two studies.…”

“…41,50,52,59,64,67,74,75,86,87,87,[89][90][91][92]101,102,106,111 In other studies, follow-up studies were recommended to observe how pharmacist interventions in chronic disease management and health promotion change over time. 36,43,45,53,54,57,65,71,79 Provider-initiated interventions such as task-shifting, the use of technology and the rearrangement of physical structures in the pharmacy to improve work ow and ergonomics have been recommended by other studies. 33,64,86,88,107,117 Providing mandatory continuous professional development by regulatory and professional bodies to community help keep abreast of the current issues, as related to practice, was advocated in the other included studies.…”