Pharmacists' Diabetes Services in Australia
Pharmacists' Diabetes Services in Australia
Objective: To implement and evaluate a specialized service for type 2 diabetes mellitus in the community pharmacy.
Design: Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible.
Intervention: Following training, pharmacists followed a clinical protocol over 9 months, with approximately monthly intervention site visits during which blood glucose readings were downloaded and discussed with the patient, interventions were documented, and goals set with each patient.
Main Outcome Measures: Quality of life, well-being, risk of nonadherence, and glycosylated hemoglobin (A1C) values at the beginning and end of the study. Blood glucose levels were measured in intervention patients only.
Results: A total of 106 intervention and 82 control patients completed the study. Patient groups were similar at baseline. Pharmacists delivered 1,459 interventions and blood glucose levels were significantly reduced in all intervention regions. The proportion of patients with A1C values greater than 7% was similar in control sites at baseline (54%) and after 9 months (61%). In intervention sites this proportion was significantly reduced, from 72% at baseline to 53% after 9 months. Well-being and the risk of nonadherence were significantly improved in intervention patients.
Conclusion: Implementation of a specialized service for diabetes in community pharmacy resulted in better diabetes control and health care outcomes for the patient.
The application of outcomes principles to the practices of health care professionals; the need to reduce escalating health care costs; the recognition of the need for continuity of care within an integrated health care system; the focus on evidence-based medicine; and the desire to optimize patient health outcomes have resulted in the concept and implementation of disease management programs.
It is possible to view disease management as a natural progression from some major health care movements of the last decade including health outcomes, health economics, and evidence-based medicine. Disease management requires a thorough understanding of the disease course.
Descriptions of certain elements of a disease management program are found throughout the literature and can be summarized as:
The case in support of applying the disease management approach to diabetes is substantial. Type 2 diabetes and its complications represent a significant health burden for the individual and the community. In Australia, approximately 900,000 people, 5% of the total population, currently have type 2 diabetes. The total cost of managing the disease and its complications is likely to exceed AU$1 billion annually in the next decade. Hence, diabetes has been identified as a national health priority area, and interventions that have the potential to improve the management of diabetes and delay the onset of complications are bound to reduce costs for the health care system.
Studies focusing on type 2 diabetes in the Australian health care system are limited. The international literature reports numerous examples of positive health outcomes when pharmacists provide professional services in controlled research situations.
Given the potential contribution of the pharmacist to the disease management process in type 2 diabetes, the lack of service models suited to the Australian health care environment and consequent lack of evidence on the potential impact of such services on the health outcomes, and costs of care for patients with type 2 diabetes, we set out to develop, implement, and evaluate a disease management service model for type 2 diabetes in community pharmacy. The model was evaluated from both the process and outcome perspectives.
Objective: To implement and evaluate a specialized service for type 2 diabetes mellitus in the community pharmacy.
Design: Parallel group, multisite, control versus intervention, repeated measures design, with three different regions in New South Wales, Australia, used as intervention regions, then matched with control regions as much as possible.
Intervention: Following training, pharmacists followed a clinical protocol over 9 months, with approximately monthly intervention site visits during which blood glucose readings were downloaded and discussed with the patient, interventions were documented, and goals set with each patient.
Main Outcome Measures: Quality of life, well-being, risk of nonadherence, and glycosylated hemoglobin (A1C) values at the beginning and end of the study. Blood glucose levels were measured in intervention patients only.
Results: A total of 106 intervention and 82 control patients completed the study. Patient groups were similar at baseline. Pharmacists delivered 1,459 interventions and blood glucose levels were significantly reduced in all intervention regions. The proportion of patients with A1C values greater than 7% was similar in control sites at baseline (54%) and after 9 months (61%). In intervention sites this proportion was significantly reduced, from 72% at baseline to 53% after 9 months. Well-being and the risk of nonadherence were significantly improved in intervention patients.
Conclusion: Implementation of a specialized service for diabetes in community pharmacy resulted in better diabetes control and health care outcomes for the patient.
The application of outcomes principles to the practices of health care professionals; the need to reduce escalating health care costs; the recognition of the need for continuity of care within an integrated health care system; the focus on evidence-based medicine; and the desire to optimize patient health outcomes have resulted in the concept and implementation of disease management programs.
It is possible to view disease management as a natural progression from some major health care movements of the last decade including health outcomes, health economics, and evidence-based medicine. Disease management requires a thorough understanding of the disease course.
Descriptions of certain elements of a disease management program are found throughout the literature and can be summarized as:
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The case in support of applying the disease management approach to diabetes is substantial. Type 2 diabetes and its complications represent a significant health burden for the individual and the community. In Australia, approximately 900,000 people, 5% of the total population, currently have type 2 diabetes. The total cost of managing the disease and its complications is likely to exceed AU$1 billion annually in the next decade. Hence, diabetes has been identified as a national health priority area, and interventions that have the potential to improve the management of diabetes and delay the onset of complications are bound to reduce costs for the health care system.
Studies focusing on type 2 diabetes in the Australian health care system are limited. The international literature reports numerous examples of positive health outcomes when pharmacists provide professional services in controlled research situations.
Given the potential contribution of the pharmacist to the disease management process in type 2 diabetes, the lack of service models suited to the Australian health care environment and consequent lack of evidence on the potential impact of such services on the health outcomes, and costs of care for patients with type 2 diabetes, we set out to develop, implement, and evaluate a disease management service model for type 2 diabetes in community pharmacy. The model was evaluated from both the process and outcome perspectives.
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