Effect of hospital pharmacist counseling on clinical outcomes of type 2 diabetes mellitus outpatients

Abstract

Objective:In Indonesia, the role of a hospital pharmacist in pharmaceutical care is still limited or even absent. This study aimed to determine whether counseling by a pharmacist could improve medication adherence, controlling the glycemic status, lipid profile, and blood pressure of type 2 diabetes mellitus (T2DM) outpatients.Methods:We conducted an interventional study at RSUD Kota Depok, a secondary public hospital, Indonesia, from April to October 2018. Counseling was given three times during the 4-month study. The study design was quasi-experimental with pretest-posttest group design on 77 respondents divided into intervention group (IGs) (n = 39 people) who received counseling and booklets from the hospital pharmacist and control group (CG) (n = 38 people) who were only given the booklets. We measured adherence with the Medication Adherence Questionnaire and conducted blood tests for fasting blood glucose (FBG), postprandial blood glucose (PPBG), glycosylated hemoglobin A1, lipid profiles (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and TG), and blood pressure measurements.Findings:In the IG, adherence parameters such as HbA1c and lipid profile improved, whereas in the CG, there were no statistically significant changes in clinical parameters and even nonadherence score increased (P = 0.008). IG showed statistically significant improvement in medication adherence, in parameters such as FBG, PPBG, and HbA1c, compared to CG. Based on the Chi-square test, IG also showed a statistically significant improvement in the number of controlled FBG (P = 0.05) and HbA1c (P < 0.001) compared to CG. In addition, a multivariate analysis showed that counseling by hospital pharmacist was 2.764 times (95% confidence interval [CI]: 1.096–6.794) and 9.964 times (95% CI: 3.434–28.917) better than no counseling in improvement of FBG and HbA1c, respectively. However, the significance disappeared after adjusted by type of medicine, duration of diabetes mellitus drug use, and medication adherence.Conclusion:Hospital pharmacist counseling is an important and significant factor in improving FBG and HbA1c levels of T2DM outpatients.

A preliminary study to evaluate the impact of pharmaceutical care services on clinical outcome and medication adherence in type 2 diabetes mellitus patients from Ethiopian perspective

“…Similar to our findings, numbers of previously reported studies have suggested that pharmacist managed diabetes mellitus care could improve LDL-C, HDL-C, TG and cholesterol levels 16,[23][24][25][29][30][31][32] . The proportion of patients who achieved target LDL-C values (<100mg/dl) and HDL-C (40mg/dL) in our study is in agreement with the study reported by Ali et al 25 , Mourao et al 17 , Wishah et al 18 , Al Mazroui et al, 20 and Hening et al, 33 . Analysis of UKPDS data by Turner et al indicated that the risk of either angina pectoris or myocardial infarction increases by 1.57 for every 1 mmol/L increase in LDL-C level, and patients with LDL-C levels higher than 3.9 mmol/L were 2.3 times as likely to develop coronary artery disease than those with LDL-C levels less than 3 mmol/L 34 .…”

“…Similar to our findings, numbers of previously reported studies have suggested that pharmacist managed diabetes mellitus care could improve LDL-C, HDL-C, TG and cholesterol levels 16 , 23 – 25 , 29 – 32 . The proportion of patients who achieved target LDL-C values (<100mg/dl) and HDL-C (40mg/dL) in our study is in agreement with the study reported by Ali et al 25 , Mourao et al 17 , Wishah et al 18 , Al Mazroui et al, 20 and Hening et al, 33 .…”

Effect of Angiotensin Receptor Blocker and Angiotensin Converting Enzyme Inhibitor on Kidney Function and Blood Potassium Level in Indonesian Type 2 Diabetes Mellitus with Hypertension: A Three-Month Cohort Study

“… 18 Compliance in taking medication will affect drug levels in the blood and the ability to maintain a constant blood-sugar level, blood pressure, and lipid profile. 19 Based on medication-adherence measurement using the pill-counting method and the MAQ questionnaire, we found that our study subjects showed relatively high compliance, thus providing a fairly robust sample in which to analyze therapeutic effectiveness.…”

Impact of pharmacist counseling on the clinical outcomes in the management of type 2 diabetes mellitus outpatients admitted to a hospital

“…They found that BGL and HbA1C improved significantly in the intervention group compared to those without intervention (p<0.001). 14 A more recent pre and post cohort study undertaken on T2DM patients in Sakaka, Saudi Arabia period April to October 2021 also argued that pharmacist-based intervention significantly improved HbA1C of the T2DM patients (p<0.05). 15 The present study was limited by the relatively small sample size and short study period.…”