Effect of pharmaceutical care on medication adherence of patients newly prescribed insulin therapy: a randomized controlled study

Abstract

BackgroundPoor adherence to insulin medications leads to a high rate of hospital admissions and poor health-related quality of life in the patients with diabetes mellitus. However, few strategies are effective and acceptable in improving medication adherence. The objectives of this study are to evaluate the effectiveness of pharmaceutical care by clinical pharmacists on medication adherence of patients newly prescribed insulin therapy.Patients and methodsA single-center, prospective randomized controlled study (pharmaceutical care group and control group) was performed from January 1, 2014 to December 30, 2014. Medication adherence was measured at the baseline and up to 12 months with Morisky–Green test and computerized dispensed medication history. The absolute change in A1c vs baseline, the change of hospitalization between two groups, and the number of patients to achieve Chinese Diabetes Society (CDS) goals at the baseline were the main outcome measures.ResultsA total of 322 patients were included in the study. After the 12-month interventions, significant improvements in the medication adherence were verified for the pharmaceutical care group according to the Morisky–Green test (50.8% of adherent patients at baseline vs 80.7% of adherent patients after 12-month interventions; P<0.01) and the computerized dispensed medication history (55.2% at baseline vs 83.3% after interventions; P<0.01), while no significant changes were verified in the control group. After follow-up, the pharmaceutical care group showed a greater percent change in A1c (2.2±0.4 vs 0.8±0.2, P<0.05).ConclusionThis study provides new evidence from a randomized controlled trial on the beneficial effect of pharmaceutical care to enhance adherence in patients newly prescribed insulin therapy. Intervention by the pharmacist might potentially improve clinical outcomes on reducing hemoglobin A1c and enhancing the number of patients fulfilling the Chinese Diabetes Society goal on hemoglobin A1c.

Pharmaceutical care-based interventions in type 2 diabetes mellitus : a systematic review and meta-analysis of randomized clinical trials

“…(33) einstein (São Paulo). 2020;18:1-14 Chung et al (28) Teaching hospital in Malaysia Ali et al (29) Community pharmacies in the United Kingdom Xin et al (38) Tongde Hospital, Hangzhou province, China As regards performance bias, no studies reported blinding to pharmacist's activities, and exchange of information between participants may have occurred in 14 studies conducted in a single setting, except the multicenter study by Siaw et al (33) That trial was thought to involve high risk of bias regarding blinding of participants and professionals, since participants in the Control Group were able to consult pharmacists, if required. (34) As regards detection bias, only one study reported blinding of raters, who were therefore unaware of groups being evaluated.…”

“…Ten studies were included in the metaanalysis, (21,(27)(28)(29)32,34,(36)(37)(38)(39) all of them with high heterogeneity for all endpoints (I 2 97% to 99%; p<0.001). The efficacy of pharmaceutical care to promote reduction of SBP, HbA1c, fasting glucose and TG levels and increase of HDL levels was demonstrated in all studies, in spite of significant heterogeneity.…”

Glycemic control through pharmaceutical care: a meta-analysis of randomized controlled trials

“…Wishah et al [21] À1.7 AE 1.24 52 À0.3 AE 1.12 54 Chen et al [22] À0.83 AE 1.31 50 0.43 AE 1.3 50 Xin et al [26] À2.36 AE 2.14 114 À0.77 AE 1.71 113 Butt et al [28] À1.19 AE 1.35 33 À0.38 AE 1.31 33 Cani et al [20] À0.57 AE 1.26 34 À0.08 AE 1.34 36 Chung et al [29] À1.4 AE 1.1 120 À0.2 AE 1.42 121 Mahwi et al [23] À2.33 AE 1.63 62 À0.47 AE 2.17 61 Ali et al [18] À1.6 AE 1.34 23 À0.6 AE 0.75 23 Chan et al [27] À1.57 AE 1.50 51 À0.40 AE 1.19 54 Jacobs et al [17] À1.8 AE 1.03 72 À0.8 AE 1.24 92 Farsaei et al [24] À1.8 AE 1.4 86 0.1 AE 1 8 6 Mehuys et al [19] À0.6 AE 1.30 153 À0.1 AE 0.96 135 Sriram et al [25] À1.71 AE 0.5 60 À0.72 AE 0.39 60 The present systematic review showed that RCTs with follow-up of >6 months report more significant mean reductions in HbA1c levels than RCTs with shorter follow-up. This suggests that better control is afforded through sustained PC interventions.…”

Effect of Patient Education for Diabetic Outpatients by a Hospital Pharmacist: A Retrospective Study

“…9) Furthermore, Xin et al showed that adherence and clinical outcomes were improved by hospital pharmacists providing pharmaceutical care working together with doctors. 10) Moreover, patient education about type 2 diabetes, prescription medications and necessary lifestyle changes in the diabetes outpatient department leads to a decrease of HbA1c level. 11) American pharmacists have more responsibilities than Japanese pharmacists.…”