Intervention and Education in Diabetes: A Pilot Project Comparing Usual Care with Pharmacist-Directed Collaborative Primary Care

Abstract

Background: Prior to this project, patients were required to drive up to 2 hours to a diabetes education centre. As a result, many patients were not receiving diabetes education, and there was little or no follow-up of patients. Significant opportunity exists for pharmacists to fill such gaps in chronic disease management services. Methods: Patients were randomly assigned to the intervention or usual care arm. Laboratory data (glycosylated hemoglobin, fasting blood glucose, lipid panel, microalbumin, systolic and diastolic blood pressure) and Diabetes Empowerment Scale short form (DES-SF) score were collected at baseline and at 6 months. Intervention patients received a medication review, 3 one-on-one education sessions with one of the study pharmacists and follow-up phone calls. Usual care patients did not receive medication reviews or education sessions, and received follow-up phone calls only if drug-related problems were detected. Drug-related problems were tracked for all patients. Referrals to other health care professionals (dietitian, homecare, public health) were made as required. Paired-sample t-tests were used to compare baseline and 6-month data. Results: Forty-five patients were enrolled in the study (intervention: 23; usual care: 17). Five patients were lost to follow-up (intervention: 2; usual care: 3). There was a statistically significant improvement in DES-SF score in the intervention group ( p < 0.001) and a decline in DES-SF score in the usual care group ( p < 0.04). There was a significant decrease in glycosylated hemoglobin in the usual care group ( p < 0.04). Referrals to other health care professionals were higher in the intervention group (I: 36; UC: 0). The number of drug-related problems detected was also greater in the intervention group (I: 83; UC: 8). The overall acceptance rate of pharmacist recommendations for drug-related problems was high in both arms (I: 81%; UC: 100%). Conclusions: Most outcome measures were not statistically significant. Further study is needed to evaluate the change in clinical outcomes. However, greater involvement of a pharmacist in diabetes management resulted in greater detection of drug-related problems and referral to other health care professionals, and promoted diabetes-related self-efficacy and appropriate self-care behaviour. Pharmacists can play an important role in the management of diabetic patients.