Chronic care model for diabetics by pharmacist home health in Bangkok Metropolitan: A community based study

Abstract

Diabetes was increased in Thailand with increasing burden of morbidity and mortality. There were 42.8% of diabetes patients in Bangkok who had been treated, but the disease conditions were uncontrolled. Diabetes with drug related problems (DRPs) frequently occurred, leading to problems of uncontrolled disease conditions. The objective of this study was to apply chronic care model (CCM) which has been introduced using medication therapy management (MTM) services by community pharmacist home health care and monitor patients' drug utilization in diabetic patients at home. An action research was conducted in the community in Bangkok Metropolitan. The uncontrolled diabetes conditions were purposively selected and identified by nurse home care team. The community pharmacists provided the MTM service 3 times as the delivery service design template that was planned over the 6-month period. The study implemented on CCM with MTM services as the main delivery system. The outcomes were evaluated on three aspect of ECHO model. Data were gathered for 288 uncontrolled diabetic patients with high prevalence of drug related problems. The number of drug were taking mean standard deviation (SD) 7.1 (3.1) per patient at enrollment. The 2.98 number problems per patient and 95.8% non-adherence were identified by community pharmacist. After 3 interventions, nonadherent patients' state was changed to adherent medication level and partially medication adherent level by 18.2 and 26.0%, respectively. The pharmacists identified problems and improved in safety issues (adverse drug reactions, drug interactions), adherence issue and effectiveness issue (subtherapeutic dosage). The clinical outcome found the average systolic and diastolic blood pressures to improve significantly in 48.6% patients with hypertension including those in pre-hypertension, stage I and stage II. The data was limited and results showed that the fasting plasma glucose (FPG) was not significantly reduced from baseline due to lack of linkage among hospital and community settings. The non-compliance issue had an effect on excessive medications per patient on the average of $543.24 per year. This study concluded that implementation MTM service through CCM by community pharmacist home health care could alleviate patients' medication utilization problems and would thus improve overall quality of patient care.

Outcomes, costs and stakeholders' perspectives associated with the incorporation of community pharmacy services into the National Health Insurance System in Thailand: a systematic review

“…When assessing the quality of the evidence by peer‐review following the criteria in Table , 18 studies were acceptable and eligible for analysis (Figure ). Of the 18 articles, one article provided more than one outcome; thus, the total number of papers when grouping by outcomes was 20 . Ten studies were excluded due to a high dropout rate and/or small sample size, as shown in Table .…”

“…Of the 18 included studies, there were 10 clinical outcome studies, two qualitative studies, three survey studies, and three economic studies that met all of the quality assessment criteria. Three studies were randomized controlled trials, three studies were clinical trials with a control group, and four were clinical trials without a control group . For the economic study, there was no analysis for the incremental costs and effects of each strategy.…”

“…Patients were highly satisfied with the pharmaceutical care service . Home‐based medical care was performed by community pharmacists in Bangkok, which improved adherence and blood pressure control in patients with diabetes . The prevalence of people with a high risk for hypertension and diabetes was 17.5% and 6.3–12.7%, respectively …”

“…Of the 18 articles, one article provided more than one outcome; thus, the total number of papers when grouping by outcomes was 20. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Ten studies were excluded due to a high dropout rate [38][39][40][41][42][43][44][45][46][47] and/or small sample size, [40,43] as shown in Table 2.…”

“…Full-text articles, no peer review articles and quality less than 75% were excluded. [20][21][22][23][24][25]28,[30][31][32] two qualitative studies, [26,33] three survey studies, [34][35][36] and three economic studies [27,29,37] that met all of the quality assessment criteria. Three studies were randomized controlled trials, [20,24,25] three studies were clinical trials with a control group, [21,22,31] and four were clinical trials without a control group.…”