Pharmacist-managed Diabetes Clinic in Malaysia - Does the Number of Follow-up Visits Really Matter?

Abstract

Background: The involvement of pharmacists in diabetes education and management has been shown to improve patient outcomes worldwide. The pharmacist-managed Diabetes Medication Therapy Adherence Clinic (DMTAC) has been introduced across public healthcare settings in Malaysia to enhance patient adherence to treatment. Objective: This study was designed to assess the effectiveness of the DMTAC in optimizing the glycemic control of diabetic patients, and to subsequently identify the relationship between the number of follow-up visits and the glycemic control. Method: This was a retrospective cohort study performed in the department of Pharmacy, Sultan Abdul Halim Hospital, Kedah, Malaysia. All the patients, who had type 2 diabetes mellitus, made at least four visits to the pharmacist-managed DMTAC during May 2014 and April 2016, and had their HbA1c levels tested once each before enrolled in the DMTAC and within the same month of the last visit, were included. Percentage of patients achieving the targeted HbA1c level of 7.5% or below, and factors associated with the achievement of the targeted HbA1c level were recorded. Results: Only 21% of patients managed to achieve the targeted HbA1c level. Higher baseline HbA1c (OR: 2.34; 95% CI: 1.14, 4.79) and FPG (OR: 1.41; 95% CI: 1.02, 1.95) levels were more likely to lead to a non-optimized HbA1c level. Conclusion: Despite the effectiveness of the DMTAC in improving the glycemic control, majority of the patients did not achieve targeted level. Number of visits to the DMTAC is not a determinant of the targeted outcome and should not be used as discharging criteria in DMTAC.

The impact of pharmacist interventions, follow-up frequency and default on glycemic control in Diabetes Medication Therapy Adherence Clinic program: a multicenter study in Malaysia

“…This study revealed a significant HbA1c reduction among diabetic patients after DMTAC visits. This was in line with two small-scale Malaysian studies conducted in a health clinic and a tertiary hospital, which demonstrated a smaller degree but significant HbA1c reduction [ 15 , 16 ]. Within expectations, we observed that patients who did not default from follow-up achieved a significantly lower level of HbA1c in both time points than defaulters.…”

The influence of pharmacist-led collaborative care on clinical outcomes in type 2 diabetes mellitus: a multicenter randomized control trial

“…In addition to the prospective Randomized Control Trials (RCTs), retrospective research studies also presented similar results. Abdullah et al ( 17 ) conducted a study that showed that the average decrease in HbA1c in diabetic patients was improved by 1.32% due to collaborative care by pharmacists. However, another study by You et al ( 18 ) presented the results that the average decrease in HbA1c with the contribution of pharmacists is 1.0% with a standard deviation of ±1.7.…”