Impact of pharmacist-involved collaborative care on the clinical, humanistic and cost outcomes of high-risk patients with type 2 diabetes (IMPACT): a randomized controlled trial

Abstract

SummaryWhat is known and objective: With the increasing prevalence of diabetes, the physician-centred model is challenged to deliver holistic care in Asia. Diabetes may be managed effectively within a multidisciplinary collaborative care model; however, evidence on its effectiveness in Asian patients is lacking. Therefore, the primary objective was to evaluate the clinical outcomes of multidisciplinary collaborative care vs physician-centred care in diabetes. The secondary objectives were to evaluate humanistic and economic outcomes among the two types of care.Methods: This 6-month prospective, open-label, parallel-arm, randomized, controlled study was conducted at four outpatient healthcare institutions. High-risk patients aged ≥21 years with uncontrolled type 2 diabetes, polypharmacy and comorbidities were included. Patients with type 1 diabetes or those who were unable to communicate independently were excluded. The control arm received usual care with referrals to nurses and dietitians as needed. The intervention arm (multidisciplinary collaborative care) was followed up with pharmacists regularly, in addition to receiving the usual care. The primary outcomes included HbA1c, systolic blood pressure, low-density lipoprotein and triglycerides. The secondary outcomes included scores from the Problem Areas in Diabetes (PAID) and the Diabetes Treatment Satisfaction Questionnaires (DTSQ), and diabetes-related health service utilization rates and costs.Results and discussion: Of 411 eligible patients, 214 and 197 patients were randomized into the intervention and control arms, respectively. At 6 months, 141 patients in the intervention arm (65.9%) and 189 patients in the control arm (95.9%) completed the study. Mean HbA1c reduced from 8.6%±1.5% at baseline to 8.1%±1.3% at 6 months in the intervention arm (P=.04), with up to mean HbA1c improvement of 0.8% in patients with greater levels of uncontrolled glycemia. Whereas the mean HbA1c in the control arm remained unchanged (8.5%±1.4%) throughout the 6-month period. Improvements in PAID and DTSQ scores, reduction in physician workload and an average cost savings of US$91.01 per patient were observed in the intervention arm over 6 months.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Efficacy of Pharmacist Based Diabetes Educational Interventions on Clinical Outcomes of Adults With Type 2 Diabetes Mellitus: A Network Meta-Analysis

“…Among the studies included in this review, n = 3 were cluster-randomized controlled trials, (Armour et al, 2004; Krass et al, 2007; Mehuys et al, 2011) whereas rest of the studies, n = 40 were parallel randomized controlled trials (Sarkadi and Rosenqvist, 2004; Clifford et al, 2005; Hayward et al, 2005; Odegard et al, 2005; Rothman et al, 2005; Suppapitiporn et al, 2005; Taylor et al, 2005; Fornos et al, 2006; Scott et al, 2006; Ko et al, 2007; Al Mazroui et al, 2009; Doucette et al, 2009; Jameson and Baty, 2010; Kang et al, 2010; Taveira et al, 2010; Cohen et al, 2011; Farsaei et al, 2011; Sriram et al, 2011; Ali et al, 2012; Chan et al, 2012; Jacobs et al, 2012; Jarab et al, 2012; Mahwi and Obied, 2013; Mourão et al, 2013; Samtia et al, 2013; Castejón et al, 2014; Chung et al, 2014; Ahmad et al, 2015; Cani et al, 2015; Chow et al, 2015; Jahangard-Rafsanjani et al, 2015; Wishah et al, 2015; Butt et al, 2016; Chen et al, 2016; Lim et al, 2016; Nascimentoa et al, 2016; Tourkmani et al, 2016; Korcegez et al, 2017; Shao et al, 2017; Siaw et al, 2017). Most of the included studies ( n = 20) were conducted in Asia (Suppapitiporn et al, 2005; Ko et al, 2007; Kang et al, 2010; Farsaei et al, 2011; Sriram et al, 2011; Chan et al, 2012; Jarab et al, 2012; Mahwi and Obied, 2013; Samtia et al, 2013; Chung et al, 2014; Chow et al, 2015; Jahangard-Rafsanjani et al, 2015; Wishah et al, 2015; Butt et al, 2016; Chen et al, 2016; Lim et al, 2016; Tourkmani et al, 2016; Shao et al, 2017; Siaw et al, 2017), followed by North America ( n = 11) (Hayward et al, 2005; Odegard et al, 2005; Rothman et al, 2005; Scott et al, 2006; Doucette et al, …”

“…Most of the included studies ( n = 20) were conducted in Asia (Suppapitiporn et al, 2005; Ko et al, 2007; Kang et al, 2010; Farsaei et al, 2011; Sriram et al, 2011; Chan et al, 2012; Jarab et al, 2012; Mahwi and Obied, 2013; Samtia et al, 2013; Chung et al, 2014; Chow et al, 2015; Jahangard-Rafsanjani et al, 2015; Wishah et al, 2015; Butt et al, 2016; Chen et al, 2016; Lim et al, 2016; Tourkmani et al, 2016; Shao et al, 2017; Siaw et al, 2017), followed by North America ( n = 11) (Hayward et al, 2005; Odegard et al, 2005; Rothman et al, 2005; Scott et al, 2006; Doucette et al, 2009; Jameson and Baty, 2010; Taveira et al, 2010; Cohen et al, 2011; Jacobs et al, 2012; Castejón et al, 2014; Korcegez et al, 2017), Europe ( n = 5) (Sarkadi and Rosenqvist, 2004; Fornos et al, 2006; Mehuys et al, 2011; Ali et al, 2012; Nascimentoa et al, 2016), Australia ( n = 4) (Armour et al, 2004; Clifford et al, 2005; Taylor et al, 2005; Krass et al, 2007), South America ( n = 2) (Mourão et al, 2013; Cani et al, 2015), and Africa ( n = 1) (Ahmad et al, 2015). …”

“…Seven studies has duration of intervention was < 6 months (Taveira et al, 2010; Farsaei et al, 2011; Mahwi and Obied, 2013; Samtia et al, 2013; Castejón et al, 2014; Jahangard-Rafsanjani et al, 2015; Lim et al, 2016) 14 studies had 6 months (Hayward et al, 2005; Krass et al, 2007; Cohen et al, 2011; Mehuys et al, 2011; Jarab et al, 2012; Mourão et al, 2013; Ahmad et al, 2015; Cani et al, 2015; Chow et al, 2015; Wishah et al, 2015; Chen et al, 2016; Nascimentoa et al, 2016; Shao et al, 2017; Siaw et al, 2017) and 22 studies' duration of intervention was more than 6 months (Armour et al, 2004; Sarkadi and Rosenqvist, 2004; Clifford et al, 2005; Odegard et al, 2005; Rothman et al, 2005; Taylor et al, 2005; Fornos et al, 2006; Scott et al, 2006; Ko et al, 2007; Johnson et al, 2008; Al Mazroui et al, 2009; Doucette et al, 2009; Jameson and Baty, 2010; Kang et al, 2010; Cohen et al, 2011; Sriram et al, 2011; Ali et al, 2012; Chan et al, 2012; Jacobs et al, 2012; Chung et al, 2014; Butt et al, 2016; Chen et al, 2016; Tourkmani et al, 2016; Korcegez et al, 2017). Pharmacist provided only educational interventions without pharmaceutical care in, n = 17 studies (Sarkadi and Rosenqvist, 2004; Hayward et al, 2005; Suppapitiporn et al, 2005; Krass et al, 2007; Al Mazroui et al, 2009; Farsaei et al, 2011; Mehuys et al, 2011; Sriram et al, 2011; Chan et al, 2012; Samtia et al, 2013; Castejón et al, 2014; Chow et al, 2015; Jahangard-Rafsanjani et al, 2015; Butt et al, 2016; Lim et al, 2016; Tourkmani et al, 2016; Shao et al, 2017) or as a member of health care team in, n = 4 studies (Ko et al, 2007; Kang et al, 2010; Taveira et al, 2010; Siaw et al, …”

“…Pharmacist provided only educational interventions without pharmaceutical care in, n = 17 studies (Sarkadi and Rosenqvist, 2004; Hayward et al, 2005; Suppapitiporn et al, 2005; Krass et al, 2007; Al Mazroui et al, 2009; Farsaei et al, 2011; Mehuys et al, 2011; Sriram et al, 2011; Chan et al, 2012; Samtia et al, 2013; Castejón et al, 2014; Chow et al, 2015; Jahangard-Rafsanjani et al, 2015; Butt et al, 2016; Lim et al, 2016; Tourkmani et al, 2016; Shao et al, 2017) or as a member of health care team in, n = 4 studies (Ko et al, 2007; Kang et al, 2010; Taveira et al, 2010; Siaw et al, 2017). In rest of the included studies ( n = 22) pharmacist provided diabetes education in combination with pharmaceutical care (Armour et al, 2004; Clifford et al, 2005; Odegard et al, 2005; Rothman et al, 2005; Taylor et al, 2005; Fornos et al, 2006; Scott et al, 2006; Doucette et al, 2009; Jameson and Baty, 2010; Cohen et al, 2011; Ali et al, 2012; Jacobs et al, 2012; Jarab et al, 2012; Mahwi and Obied, 2013; Mourão et al, 2013; Chung et al, 2014; Ahmad et al, 2015; Cani et al, 2015; Wishah et al, 2015; Chen et al, 2016; Nascimentoa et al, 2016; Korcegez et al, 2017) (detail for contents of pharmaceutical care intervention for individual study, is presented in Supplementary Table 2), in a varied healthcare settings, such as primacy care clinics, community pharmacies and hospital settings.…”

“…After final assessment n = 20 studies which reported for BMI (Clifford et al, 2005; Fornos et al, 2006; Scott et al, 2006; Krass et al, 2007; Al Mazroui et al, 2009; Kang et al, 2010; Taveira et al, 2010; Ali et al, 2012; Chan et al, 2012; Jarab et al, 2012; Mourão et al, 2013; Samtia et al, 2013; Castejón et al, 2014; Jahangard-Rafsanjani et al, 2015; Wishah et al, 2015; Butt et al, 2016; Lim et al, 2016; Tourkmani et al, 2016; Korcegez et al, 2017; Shao et al, 2017) n = 16 for FBS (Clifford et al, 2005; Suppapitiporn et al, 2005; Fornos et al, 2006; Al Mazroui et al, 2009; Farsaei et al, 2011; Sriram et al, 2011; Jarab et al, 2012; Mahwi and Obied, 2013; Mourão et al, 2013; Samtia et al, 2013; Chung et al, 2014; Wishah et al, 2015; Butt et al, 2016; Lim et al, 2016; Korcegez et al, 2017; Shao et al, 2017) n = 19 studies for SBP (Clifford et al, 2005; Fornos et al, 2006; Scott et al, 2006; Al Mazroui et al, 2009; Doucette et al, 2009; Taveira et al, 2010; Cohen et al, 2011; Ali et al, 2012; Chan et al, 2012; Jacobs et al, 2012; Mourão et al, 2013; Castejón et al, 2014; Ahmad et al, 2015; Jahangard-Rafsanjani et al, 2015; Lim et al, 2016; Tourkmani et al, 2016; Korcegez et al, 2017; Shao et al, 2017; Siaw et al, 2017) n = 17 studies for DBP (Clifford et al, 2005; Fornos et al, 2006; Scott et al, 2006; Al Mazroui et al, 2009; Doucette et al, 2009; Correr et al, 2011; Ali et al, 2012; Chan et al, 2012; Jacobs et al, 2012; Jarab et al, 2012; Mourão et al, 2013; Castejón et al, 2014; Ahmad et al, 2015; Jahangard-Rafsanjani et al, 201...…”