A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan

Javaid, Zaida; Imtiaz, Unaiza; Khalid, Imtiaz M.; Saeed, Hamid; Khan, Razaullah; Islam, Muhammad; Saleem, Zikria; Sohail, Muhammad; Danish, Zeeshan; Batool, Farah; Anwer, Naveed

doi:10.1186/s12913-019-4274-z

Cited by 25 publications

(80 citation statements)

References 41 publications

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“…For this parameter, the difference in change between both groups ranged from +2.1 mg/dL to -27 mg/dL, and was reported as statistically significant in only seven studies (33.3%). 27 , 29 , 35 , 39 , 40 , 45 , 57 …”

Section: Resultsmentioning

confidence: 99%

Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

Pousinho

Morgado

Plácido

et al. 2020

Pharm Pract (Granada)

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Background: Type 2 diabetes mellitus is a chronic disease that is reaching epidemic proportions worldwide. It is imperative to adopt an integrated strategy, which involves a close collaboration between the patient and a multidisciplinary team of which pharmacists should be integral elements. Objective: This work aims to identify and summarize the main effects of interventions carried out by clinical pharmacists in the management of patients with type 2 diabetes, considering clinical, humanistic and economic outcomes. Methods: PubMed and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials assessing the effectiveness of such interventions compared with usual care that took place in hospitals or outpatient facilities. Results: This review included 39 studies, involving a total of 5,474 participants. Beneficial effects were observed on various clinical outcomes such as glycemia, blood pressure, lipid profile, body mass index and coronary heart disease risk. For the following parameters, the range for the difference in change from baseline to final follow-up between the intervention and control groups was: HbA1c, -0.05% to -2.1%; systolic blood pressure, +3.45 mmHg to -10.6 mmHg; total cholesterol, +10.06 mg/dL to -32.48 mg/dL; body mass index, +0.6 kg/m2 to -1.94 kg/m2; and coronary heart disease risk, -3.0% and -12.0% (among the studies that used Framinghan prediction method). The effect on medication adherence and health-related quality of life was also positive. In the studies that performed an economic evaluation, the interventions proved to be economically viable. Conclusions: These findings support and encourage the integration of clinical pharmacists into multidisciplinary teams, underlining their role in improving the management of type 2 diabetes.

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Section: Resultsmentioning

confidence: 99%

Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

Pousinho

Morgado

Plácido

et al. 2020

Pharm Pract (Granada)

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“…performed by pharmacists such as care coordination, medication review and counseling, and prescription suggestions to physicians [28,[33][34][35]37,38,41,42,47,48,50,51,55,57]. All pharmacist task-sharing interventions incorporated diabetes self-management education, but no trial included education alone.…”

Section: Plos Medicinementioning

confidence: 99%

“…No intervention involved pharmacists independently prescribing or titrating medications. All 11 of the studies that described the study setting were conducted in an urban area [33,35,37,38,41,42,48,50,51,55,57]. The intensity of interventions was incompletely reported but ranged from 3 to 16 telephone calls or face-toface visits.…”

Section: Plos Medicinementioning

confidence: 99%

“…In the sensitivity analysis of studies not at high risk of bias (n = 21 trials), the overall HbA1c mean difference was −0.20% (95% CI −0.32% to −0.08%, I 2 71.8% [95% CI 56.2% to 81.8%]; S11-S13 Appendices). In the sensitivity analysis using the leave-one-out method, we found that exclusion of the study with the largest effect size [42] would result in a HbA1c mean difference of −0.39% (95% CI −0.52% to −0.26%, I 2 84.5%; S14 Appendix).…”

Section: Plos Medicinementioning

confidence: 99%

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Health system interventions for adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

et al. 2020

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Background Effective health system interventions may help address the disproportionate burden of diabetes in low- and middle-income countries (LMICs). We assessed the impact of health system interventions to improve outcomes for adults with type 2 diabetes in LMICs. Methods and findings We searched Ovid MEDLINE, Cochrane Library, EMBASE, African Index Medicus, LILACS, and Global Index Medicus from inception of each database through February 24, 2020. We included randomized controlled trials (RCTs) of health system interventions targeting adults with type 2 diabetes in LMICs. Eligible studies reported at least 1 of the following outcomes: glycemic change, mortality, quality of life, or cost-effectiveness. We conducted a meta-analysis for the glycemic outcome of hemoglobin A1c (HbA1c). GRADE and Cochrane Effective Practice and Organisation of Care methods were used to assess risk of bias for the glycemic outcome and to prepare a summary of findings table. Of the 12,921 references identified in searches, we included 39 studies in the narrative review of which 19 were cluster RCTs and 20 were individual RCTs. The greatest number of studies were conducted in the East Asia and Pacific region (n = 20) followed by South Asia (n = 7). There were 21,080 total participants enrolled across included studies and 10,060 total participants in the meta-analysis of HbA1c when accounting for the design effect of cluster RCTs. Non-glycemic outcomes of mortality, health-related quality of life, and cost-effectiveness had sparse data availability that precluded quantitative pooling. In the meta-analysis of HbA1c from 35 of the included studies, the mean difference was −0.46% (95% CI −0.60% to −0.31%, I2 87.8%, p < 0.001) overall, −0.37% (95% CI −0.64% to −0.10%, I2 60.0%, n = 7, p = 0.020) in multicomponent clinic-based interventions, −0.87% (−1.20% to −0.53%, I2 91.0%, n = 13, p < 0.001) in pharmacist task-sharing studies, and −0.27% (−0.50% to −0.04%, I2 64.1%, n = 7, p = 0.010) in trials of diabetes education or support alone. Other types of interventions had few included studies. Eight studies were at low risk of bias for the summary assessment of glycemic control, 15 studies were at unclear risk, and 16 studies were at high risk. The certainty of evidence for glycemic control by subgroup was moderate for multicomponent clinic-based interventions but was low or very low for other intervention types. Limitations include the lack of consensus definitions for health system interventions, differences in the quality of underlying studies, and sparse data availability for non-glycemic outcomes. Conclusions In this meta-analysis, we found that health system interventions for type 2 diabetes may be effective in improving glycemic control in LMICs, but few studies are available from rural areas or low- or lower-middle-income countries. Multicomponent clinic-based interventions had the strongest evidence for glycemic benefit among intervention types. Further research is needed to assess non-glycemic outcomes and to study implementation in rural and low-income settings.

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“…1 Essas reformas estão encorajando o rearranjo do papel do farmacêutico nesse sistema e o modelo da prática centrada no paciente está tomando força na profissão, desenvolvendo novos conceitos de serviços farmacêuticos. [1][2][3] Desde então, a atenção farmacêutica está se disseminando pelo mundo 4 e, hoje, sua prática está presente em todos os níveis do sistema de saúde. 5 O conceito engloba a otimização da terapia medicamentosa e a minimização de problemas relacionados ao medicamento e objetiva favorecer a melhora na qualidade de vida dos pacientes.…”

Section: Introductionunclassified

Artigo de revisão: Estratégias da atenção farmacêutica na atenção primária à saúde em diferentes países

Oliveira¹,

Araújo²

2022

JAFF

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Resumo: Contexto: A atenção primária tem passado por significativas transformações nas últimas décadas, levando o profissional farmacêutico a ter que reinventar sua atuação, saindo das funções tradicionais para a realização de ações clínicas complexas. Objetivo: analisar as estratégias de intervenção fundamentadas na prática da atenção farmacêutica na atenção básica à saúde em diferentes países. Método: Utilizou-se o PRISMA como protocolo e a síntese narrativa para reportar os achados. Foram utilizadas três bases de dados eletrônicas para a realização das pesquisas. A qualidade dos artigos foi avaliada pela plataforma Sucupira e os riscos de viés foram analisados individualmente em cada pesquisa. Resultados: Foram encontrados 1.498 itens nas bases de dados eletrônicas. Após todas as triagens, cinco artigos tornaram-se as principais referências para esta revisão. Conclusão: As intervenções mostraram-se heterogêneas e, de uma forma geral, as estratégias utilizadas tiveram um impacto positivo.

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A randomized control trial of primary care-based management of type 2 diabetes by a pharmacist in Pakistan

Cited by 25 publications

References 41 publications

Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

Clinical pharmacists´ interventions in the management of type 2 diabetes mellitus: a systematic review

Health system interventions for adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

Artigo de revisão: Estratégias da atenção farmacêutica na atenção primária à saúde em diferentes países

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