Pharmacist intervention for glycaemic control in the community (the RxING study)

Abstract

ObjectiveTo determine the effect of a community pharmacist prescribing intervention on glycaemic control in patients with poorly controlled type 2 diabetes.DesignPragmatic, before–after design.Setting12 community pharmacies in Alberta, Canada.ParticipantsType 2 diabetes receiving oral hypoglycaemic medications and with glycated haemoglobin (HbA1c) of 7.5–11%.InterventionPharmacists systematically identified potential candidates by inviting patients with type 2 diabetes to test their HbA1c using validated point-of-care technology. Pharmacists prescribed 10 units of insulin glargine at bedtime, adjusted by increments of 1 unit daily to achieve a morning fasting glucose of ≤5.5 mmol/L. The patients were followed up at 2, 4, 8, 14, 20 and 26 weeks.Primary outcomeChange in HbA1c from baseline to week 26.Secondary outcomesProportion of patients achieving target HbA1c, changes in oral hypoglycaemic agents, quality of life and patient satisfaction, persistence on insulin glargine, number of insulin dosage adjustments per patient and number of hypoglycaemic episodes.ResultsWe screened 365 patients of whom 111 were eligible. Of those, 100 (90%) were enrolled in the study; all 11 patients who did not consent refused to use insulin. Average age was 64 years (SD 10.4), while average diabetes duration was 10.2 years (SD 7). HbA1c was reduced from 9.1% (SD 1) at baseline to 7.3% (SD 0.9); a change of 1.8% (95% CI 1.4 to 2, p<0.001). Fasting plasma glucose was reduced from 11 (SD 3.3) to 6.9 mmol/L (SD 1.8); a change of 4.1 mmol/L (95% CI of 3.3 to 5, p=0.007). Fifty-one per cent of the patients achieved the target HbA1c of ≤7% at the end of the study.ConclusionsThis is the first completed study of independent prescribing by pharmacists. Our results showed similar improvements in glycaemic control as previous physician-led studies. RxING provides further evidence for the benefit of pharmacist care in diabetes.Trial registrationclinicaltrials.gov; Identifier: NCT01335763.

The Current Scenario of Clinical Pharmacy Service in the Management of Patients with Diabetes Mellitus and Related Complications: Review Article

“…Indicated that, a good control in blood glucose and lipid levels in patients with diabetes were seen in the pharmacist-run program. 42 The first completed study of independent prescribing by pharmacists conducted by Al Hamarneh et al, (2013) showed similar improvements with above studies in glycaemic control. The value of HbA1c was reduced and above 50% of the patients were achieved the target (≤7%), which represents pharmacist prescribing intervention in patients with poorly controlled diabetes clinically important in glycemic control.…”

“…The value of HbA1c was reduced and above 50% of the patients were achieved the target (≤7%), which represents pharmacist prescribing intervention in patients with poorly controlled diabetes clinically important in glycemic control. 53 Another cohort study was conducted with 126 patients to assess the impact of a pharmacist-managed insulin titration program compared to standard medical care on deprived glycemic control. The pharmacist-run group showed a better improvement in A1c outcome, compared to the standard care.…”

A scoping review of research on the prescribing practice of Canadian pharmacists

“…Seven studies showed benefit in clinical patient outcomes. These studies found improved risk factor control in patients with prior stroke, 25 reduced systolic blood pressure 26,31 and low-density lipoprotein cholesterol, 27 improved glycemic control in patients with poorly controlled type 2 diabetes 22 and improved quality of life in patients with uncontrolled type 2 diabetes in a cost-effective manner. 32 Better chronic disease management as well as significant symptomatic improvement was reported by 81% of patients when pharmacists prescribed CLInICAL RevIeW medications for minor ailments (i.e., ambulatory conditions) in Saskatchewan.…”

“…18,[22][23][24][25][26][27][28][29][30][31][32]48 Three articles evaluating the outcomes of pharmacist prescribing on the use of antihypertensives, 24 cardiovascular risk reduction 28 and health care use 23 were on study design and did not report any results. All remaining studies reported benefits of pharmacist prescribing.…”

“…Quantitative articles used surveys (8 studies), 2,14-20 experiments (3 studies), [21][22][23] randomized controlled trials (5 studies) [24][25][26][27][28] and others (4 studies). [29][30][31][32] Qualitative studies explored perceptions of pharmacists 33 or pharmacy students 34 (2 studies), stakeholders (3 studies), [35][36][37] media (1 study) 38 and different factors influencing the practice change (5 studies).…”