Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus
Version of Record online: 11 FEB 2009
© 2009 The Authors. Journal compilation © 2009 The British Pharmacological Society
British Journal of Clinical Pharmacology
Volume 67, Issue 5, pages 547–557, May 2009
How to Cite
Al Mazroui, N. R., Kamal, M. M., Ghabash, N. M., Yacout, T. A., Kole, P. L. and McElnay, J. C. (2009), Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus. British Journal of Clinical Pharmacology, 67: 547–557. doi: 10.1111/j.1365-2125.2009.03391.x
- Issue online: 24 APR 2009
- Version of Record online: 11 FEB 2009
- Received 8 November 2008Accepted 3 February 2009
- cardiovascular risk factors;
- glycosylated haemoglobin;
- pharmaceutical care;
- Type 2 diabetes mellitus
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
• Pharmaceutical care programmes delivered by pharmacists are known to improve quality of care for both ambulatory and hospitalized patients with a variety of chronic and acute conditions.
• Reduction of HbA1c and normalization of blood pressure are key targets for diabetes care programmes, since they are key to reducing diabetes complications.
• Good knowledge about disease, medications, diet and exercise requirements can improve the effectiveness of self-management of diabetes.
WHAT THIS STUDY ADDS
• In a randomized, controlled clinical trial, a comprehensive pharmaceutical care programme (consisting of patient education and advice on medication adherence, metabolic control and life style) delivered by a clinical pharmacist over a 12-month period, significantly improved glycaemic control and health-related quality of life in Type 2 diabetes patients attending a military hospital outpatient clinic in the United Arab Emirates (UAE).
• A significant reduction in HbA1c was important in the reduction of the 10-year coronary heart disease risk scores (by British National Formulary and Framingham methods) seen in patients who received the present care programme.
• The outcomes of this study advocate an increased role for clinical pharmacists in the healthcare system in the UAE.
AIMS To examine the influence of a pharmaceutical care programme on disease control and health-related quality of life in Type 2 diabetes patients in the United Arab Emirates.
METHODS A total of 240 Type 2 diabetes patients were recruited into a randomized, controlled, prospective clinical trial with a 12-month follow-up. A range of clinical measures, medication adherence and health-related quality of life (Short Form 36) were evaluated at baseline and up to 12 months. Intervention group patients received pharmaceutical care from a clinical pharmacist, whereas control group patients received their usual care from medical and nursing staff. The primary outcome measure was change in HbA1c. British National Formulary and Framingham scoring methods were used to estimate changes in 10-year coronary heart disease risk scores in all patients.
RESULTS A total of 234 patients completed the study. Significant reductions (P < 0.001) in mean values (baseline vs. 12 months; 95% confidence interval) of HbA1c[8.5% (8.3, 8.7) vs. 6.9% (6.7, 7.1)], systolic [131.4 mmHg (128.1, 134.7) vs. 127.2 mmHg (124.4, 130.1)] and diastolic blood pressure [85.2 mmHg (83.5, 86.8) vs. 76.3 mmHg (74.9, 77.7)] were observed in the intervention group; no significant changes were noted in the control group. The mean Framingham risk prediction score in the intervention group was 10.56% (9.7, 11.4) at baseline; this decreased to 7.7% (6.9, 8.5) (P < 0.001) at 12 months but remained unchanged in the control group.
CONCLUSIONS The pharmaceutical care programme resulted in better glycaemic control and reduced cardiovascular risk scores in Type 2 diabetes patients over a 12-month period.