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Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial

Els Mehuys UGent, Lucas Van Bortel UGent, Leen De Bolle UGent, Inge Van Tongelen UGent, Lieven Annemans UGent, Jean Paul Remon UGent and Mimi Giri UGent (2011) JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS. 36(5). p.602-613
abstract
What is known and Objective: There is little evidence from well-designed randomized controlled trials of the impact of community pharmacist intervention on the clinical management of patients with type 2 diabetes. It is also not known how sustainable any observed effects on glycaemic control are, over time. This study was initiated to address both these issues. Methods: A 6-month, randomized, controlled parallel-group trial in 66 community pharmacies was conducted in Belgium. Patients were randomly assigned to receive usual pharmacist care (n = 135) or a predefined pharmacist intervention (n = 153). The intervention mainly focused on correct medication use, medication adherence and healthy lifestyle promotion. Primary outcome was glycaemic control, as measured by fasting plasma glucose and HbA1c. Sustainability of changes in glycaemic control was assessed by additional glucose measurements 18 months after the end of the study. Results and Discussion: The intervention significantly reduced HbA1c (between-group difference: 0.5%, P = 0.009). The largest impact on HbA1c was observed when pharmacotherapy changes (i.e., type and/or dose of hypoglycaemic agents) initiated by the physician were sustained with pharmaceutical care: HbA1c was reduced by 1.05% in the intervention group, whose medication was changed, compared with a reduction of 0.02% in the therapy-modification only, group. It was also found that the diabetes education program resulted in improved self-management and better knowledge of diabetes. Eighteen months after the end of the formal study period, the mean HbA1c of the intervention group did not differ significantly from the control group (7.4% vs. 7.2%). What is new and Conclusion: This study provides new evidence, from a randomized controlled trial, of the beneficial effect of community pharmacist intervention in the clinical management of type 2 diabetic patients. However, questions remain about the sustainability of the observed improvements.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
community pharmacy, pharmaceutical care, randomized controlled trial, type 2 diabetes, PHARMACEUTICAL CARE, DRUG-THERAPY, MANAGEMENT, MEDICATION, ADHERENCE, QUALITY, MODEL
journal title
JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS
J. Clin. Pharm. Ther.
volume
36
issue
5
pages
602 - 613
Web of Science type
Article
Web of Science id
000295049800009
JCR category
PHARMACOLOGY & PHARMACY
JCR impact factor
1.57 (2011)
JCR rank
177/259 (2011)
JCR quartile
3 (2011)
ISSN
0269-4727
DOI
10.1111/j.1365-2710.2010.01218.x
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2014474
handle
http://hdl.handle.net/1854/LU-2014474
date created
2012-02-01 11:44:07
date last changed
2012-02-15 12:46:31
@article{2014474,
  abstract     = {What is known and Objective: There is little evidence from well-designed randomized controlled trials of the impact of community pharmacist intervention on the clinical management of patients with type 2 diabetes. It is also not known how sustainable any observed effects on glycaemic control are, over time. This study was initiated to address both these issues. 
Methods: A 6-month, randomized, controlled parallel-group trial in 66 community pharmacies was conducted in Belgium. Patients were randomly assigned to receive usual pharmacist care (n = 135) or a predefined pharmacist intervention (n = 153). The intervention mainly focused on correct medication use, medication adherence and healthy lifestyle promotion. Primary outcome was glycaemic control, as measured by fasting plasma glucose and HbA1c. Sustainability of changes in glycaemic control was assessed by additional glucose measurements 18 months after the end of the study. 
Results and Discussion: The intervention significantly reduced HbA1c (between-group difference: 0.5\%, P = 0.009). The largest impact on HbA1c was observed when pharmacotherapy changes (i.e., type and/or dose of hypoglycaemic agents) initiated by the physician were sustained with pharmaceutical care: HbA1c was reduced by 1.05\% in the intervention group, whose medication was changed, compared with a reduction of 0.02\% in the therapy-modification only, group. It was also found that the diabetes education program resulted in improved self-management and better knowledge of diabetes. Eighteen months after the end of the formal study period, the mean HbA1c of the intervention group did not differ significantly from the control group (7.4\% vs. 7.2\%). 
What is new and Conclusion: This study provides new evidence, from a randomized controlled trial, of the beneficial effect of community pharmacist intervention in the clinical management of type 2 diabetic patients. However, questions remain about the sustainability of the observed improvements.},
  author       = {Mehuys, Els and Van Bortel, Lucas and De Bolle, Leen and Van Tongelen, Inge and Annemans, Lieven and Remon, Jean Paul and Giri, Mimi},
  issn         = {0269-4727},
  journal      = {JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS},
  keyword      = {community pharmacy,pharmaceutical care,randomized controlled trial,type 2 diabetes,PHARMACEUTICAL CARE,DRUG-THERAPY,MANAGEMENT,MEDICATION,ADHERENCE,QUALITY,MODEL},
  language     = {eng},
  number       = {5},
  pages        = {602--613},
  title        = {Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial},
  url          = {http://dx.doi.org/10.1111/j.1365-2710.2010.01218.x},
  volume       = {36},
  year         = {2011},
}

Chicago
Mehuys, Els, Lucas Van Bortel, Leen De Bolle, Inge Van Tongelen, Lieven Annemans, Jean Paul Remon, and Mimi Giri. 2011. “Effectiveness of a Community Pharmacist Intervention in Diabetes Care: a Randomized Controlled Trial.” Journal of Clinical Pharmacy and Therapeutics 36 (5): 602–613.
APA
Mehuys, E., Van Bortel, L., De Bolle, L., Van Tongelen, I., Annemans, L., Remon, J. P., & Giri, M. (2011). Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS, 36(5), 602–613.
Vancouver
1.
Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, et al. Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS. 2011;36(5):602–13.
MLA
Mehuys, Els, Lucas Van Bortel, Leen De Bolle, et al. “Effectiveness of a Community Pharmacist Intervention in Diabetes Care: a Randomized Controlled Trial.” JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS 36.5 (2011): 602–613. Print.