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

Abstract

Background Pharmacist’s involvement in optimizing medication adherence among diabetic patients has been implemented for over a decade. Diabetes Medication Therapy Adherence Clinic (DMTAC) was set up to educate diabetic patients, monitor treatment outcomes, and manage drug-related problems. While evidence shows that pharmacist-led DMTAC was effective in reducing HbA1c, there was limited data regarding the impact of different intervention types and default to follow-up on glycemic control. Aim To assess the impact DMTAC on glycemic control and the difference in glycemic control between hospital and health clinic settings as well as defaulter and non-defaulter. In addition, the impact of pharmacist’s interventions, DMTAC follow-up frequencies, and duration of diabetes on glycemic control were also determined. Methods A retrospective study was conducted among diabetes patients under DMTAC care between January 2019 and June 2020 in five hospitals and 23 primary health clinics. Patients’ demographics data, treatment regimens, frequencies of DMTAC visits, defaulter (absent from DMTAC visits) and types of pharmacists’ intervention were retrieved from patients’ medical records and electronic database. HbA1c was collected at baseline, 4–6 months (post-1), and 8–12 months (post-2). Results We included 956 patients, of which 60% were females with a median age of 58.0 (IQR: 5.0) years. Overall, the HbA1c reduced significantly from baseline (median: 10.2, IQR: 3.0) to post-1 (median: 8.8, IQR: 2.7) and post-2 (median: 8.3, IQR: 2.6%) (p < 0.001). There were 4317 pharmacists’ interventions performed, with the majority being dosage adjustment (n = 2407, 55.8%), followed by lab investigations (849, 19.7%), drugs addition (653, 15.1%), drugs discontinuation (408, 9.5%). Patients treated in hospitals received significantly more interventions than those treated in primary health clinics (p < 0.001). We observed significantly less reduction in HbA1c in DMTAC follow-up defaulters than non-defaulters after 1 year (− 1.02% vs. − 2.14%, p = 0.001). Frequencies of DMTAC visits (b: 0.19, CI: 0.079–0.302, p = 0.001), number of dosage adjustments (b: 0.83, CI: 0.015–0.151, p = 0.018) and number of additional drugs recommended (b: 0.37, CI: 0.049–0.691, p = 0.024) had positive impact on glycemic control whereas duration of diabetes (b: − 0.0302, CI: − 0.0507, − 0.007, p = 0.011) had negative impact. Conclusion Glycemic control improved significantly and sustained up to one year among patients in pharmacists-led DMTAC. However, DMTAC defaulters experienced poorer glycemic control. Considering more frequent visits and targeted interventions by pharmacists at DMTAC resulted in improved HbA1c control, these strategies should be taken into account for future program planning.

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

“…An average decrease in diastolic blood pressure (DBP) in patients in the control arm was identified as being 3.69 mmHg ( p < 0.001), whereas such a reduction was 7.58 mmHg (p < 0.001, η 2 0.09) in patients in the intervention arm. These observations from the present study are consistent with the findings of research conducted by Lim et al ( 9 ), according to Lim et al ( 9 ) the decrease in average mean SBP was 3.55 mmHg. In the control arm, it was increased up to 5.76 mmHg, which was considered uncontrolled blood pressure, according to CPG Malaysia.…”

“…However, the reduction in HbA1c specifically among patients in the intervention group, was considerably greater compared to patients in the control group due to the collaborative care involving pharmacists. These results are in line with a randomized controlled study in clinical research by Lim et al ( 9 ), according to which the decrease in average HbA1c in the intervention group was 0.91 and 0.08% in the control group, which is statistically significant ( p ≤ 0.011) among both groups. The observations of the present study are consistent with the randomized controlled trial conducted by Butt et al ( 11 ), which was conducted in the “Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Malaysia.” HbA1c in the study subjects was reduced significantly, from 9.677 to 8.48% ( p ≤ 0.001) in the intervention arm of the study; however, no statistical reduction in HbA1c was observed in the control arm of the study (9.64–9.26%, p = 0.14).…”

“…In the control arm, it was increased up to 5.76 mmHg, which was considered uncontrolled blood pressure, according to CPG Malaysia. According to the same research ( 9 ), the average diastolic blood pressure was reduced up to 2.59 mmHg in the pharmacist collaborative care study arm. Furthermore, the results of the present study are also supported by the findings of Albsoul-Younes et al (2011) ( 10 ).…”

“…Collaborative care involving healthcare professionals, especially pharmacists, consistently leads to positive disease management outcomes. In Malaysia, these services are effectively provided through Medication Adherence Therapy Clinics (DMTAC), which cover a wide range of lifestyle diseases ( 9 ). The present study is a randomized, prospective, and multicenter observational research.…”

Effects of pharmacist-led interventions on glycaemic control, adherence, disease management and health-related quality of life in patients with type 2 diabetes: a protocol for a network meta-analysis

“…Extensive global studies have demonstrated the effectiveness of pharmacist-based interventions on patients with diabetes, resulting in improved quality of care and clinical outcomes 23 26 28–30. In addition, several systematic reviews31–34 have identified various non-pharmacological pharmacist-led interventions, such as diabetes education,35–38 medication review,39 drug counselling/advice,40 41 lifestyle modification, self-care, peer support and behavioural intervention 42–44…”