Impact of Pharmacists-Led Interventions in Primary Care for Adults with Type 2 Diabetes on HbA1c Levels: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection
2.2.1. Inclusion Criteria
2.2.2. Exclusion Criteria
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- they were retrospective studies, observational studies and quasi-experimental pretest posttest designs with no control group;
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- the intervention was not considered to be part of the primary care (e.g., hospital setting, clinical pharmacist interventions);
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- there was no physical encounter between the pharmacist and the patient or if no education or counselling was proposed by the pharmacist;
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- the evaluated intervention was performed by a multidisciplinary team (e.g., pharmacists associated with nurses, dieticians, endocrinologist) because it would have been difficult to estimate the precise impact of the pharmacist, except for the cooperation between the pharmacist and the general practitioner because it constitutes the cornerstone of primary care and the pharmacist often makes recommendations to the general practitioner;
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- they evaluated the impact of the intervention on other chronic diseases (e.g., arterial hypertension) with no distinct results for the patients with diabetes.
2.3. Outcomes
2.4. Data Extraction
2.5. Risk of Bias Assessment
2.6. Statistical Analysis
3. Results
3.1. Study Characteristics
3.2. Risk of Bias Assessment
3.3. Meta-Analysis
3.3.1. Primary Outcome
3.3.2. Subgroups Analysis
3.3.3. Secondary Outcome
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Appendix A
Appendix B
Appendix C
References
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Study | Country; HDI | Study Design | Intervention Duration | Setting | Intervention Type | Frequency | Pharmacist Training | Inclusion/Exclusion Criteria |
---|---|---|---|---|---|---|---|---|
Ali 2012 [26] | United-Kingdom; HDI = 0.932 | Randomized controlled study; Randomization at the patient level | 12 months | 2 community pharmacies | Pharmaceutical care package: targeted medicine use review (compliance and counseling), comprehensive and individualized education, lifestyle modification counseling | Every month the first 2 months, then every 3 months | 8 h training program: update on diabetes management and referrals, overview of the use of diagnostic equipment | T2D, >18 y/o, oral medication (no insulin), no significant co-morbidity, HbA1C ≥ 7% |
Ayadurai 2018 [27] | Malaysia; HDI = 0.810 | Randomized controlled study; Randomization at the patient level | 6 months | 7 primary healthcare practices (health clinics) | Simplified tool to manage T2D: medication related concerns, recommendations to the prescribers, education | Monthly | 2h online training program to use the tool | T2D, >21 y/o, on multiple medications (including for other chronic conditions) and/or have other diseases in addition to diabetes, HbA1C > 8% (or fasting blood sugar > 7.0 mmol/L or 2 h post prandial sugar level > 8.5 mmol/L) |
Correr 2011 [28] | Brazil; HDI = 0.765 | Quasi-experimental controlled study | 12 months | 6 community pharmacies | PFU program: comprehensive and systematic medication outcome assessment, suggesting changes in the medication, education | Monthly | Training on basic concepts and procedures of pharmacotherapy follow-up, diabetes care, glucose and blood pressure measurement | T2D, >30 y/o, using either oral hypoglycemiants or insulin |
Doucette 2009 [29] | USA; HDI = 0.926 | Randomized controlled study; Randomization at the patient level | 12 months | 7 community pharmacies | Assessment of clinical markers, review of medications and self-care behaviors, identifying drug therapy problems, recommendation of drug therapy change and education (diabetes self-care) | Quarterly | Training in diabetes management: 15 h self-study certificate program in diabetes management and live training (pathophysiology, therapeutics, self-care…) | T2D, HbA1C ≥ 7.0% |
Fajriansyah 2020 [30] | Indonesia; HDI = 0.718 | Randomized controlled trial; Randomization at the center level | 6 months | 4 primary health care centers (Puskesmas) | Education about T2D causes and symptoms, importance of therapy, therapies available, guidelines for the treatment, purpose of controlling blood sugar levels, lifestyle | Monthly | 8 h training with experts | T2D, 18 ≤ age ≥ 65 y/o, HbA1C ≥ 6.5% |
Fornos 2006 [31] | Spain; HDI = 0.904 | Randomized controlled trial; Randomization at the patient level | 13 months | 14 community pharmacies | PFU program: prevent, detect and solve the problems related to the drugs used, information about drug (correct use, adverse reaction, interaction), assessment of lifestyle and health education actions | Monthly | Educational program to increase knowledge about diabetes and 18h of trainingin the PFU program and in the proper use of the measuring tools | T2D, on oral antidiabetics > 2 months |
Jahangard-Rafsanjani 2014 [32} | Iran; HDI = 0.783 | Randomized controlled trial; Randomization at the patient level | 5 months | 1 community pharmacy | Diabetes education program on diet management, physical activity, diabetes complications, discussion about medication-related problems and self-care issues | Monthly | 4 h training: pathophysiology and pharmacotherapy, 3-day workshop on diabetes education | T2D, oral hypoglycemic medications, HbA1C > 7% within the preceding month |
Javaid 2019 [33] | Pakistan; HDI = 0.557 | Randomized controlled trial; Randomization at the patient level | 9 months | 1 primary care clinic | Comprehensive pharmaceutical care plan: assessment for drug related problems, suggestions for therapy changes, verbal and readable education (insulin administration, medication adherence, treatment goals, self-care, dietary, lifestyle, monitoring of blood glucose, footcare and hygiene...) | Quarterly | NA | T2D, >18 y/o, HbA1c > 8%, |
Krass 2007 [34] | Australia; HDI = 0.944 | Randomized controlled trial; Randomization at the pharmacy level | 6 months | 56 community pharmacies | Review of self-monitoring of blood glucose, disease, medication, self-management and lifestyle education (physical activity, weight loss), adherence support, medication review and detection of drug-related problems | Monthly | Diabetes education manual for self-directed learning and a 2-day workshop (pharmacotherapy, dietary management, role-playing exercises, training on the use of measuring tools) | T2D with:
|
Mehuys 2011 [35] | Belgium; HDI = 0.931 | Randomized controlled trial; Randomization at the pharmacy level | 6 months | 66 community pharmacies | Education on diabetes and its complications, about the correct use of oral hypoglycemic agents, facilitation of medication adherence, healthy lifestyle education, reminders about annual eye and foot examinations | At each prescription-refill visit | Training session on the pathophysiology of diabetes and its non-pharmacological and pharmacological management | T2D, 45 ≤ age ≥ 75, BMI ≥ 25 kg/m2, treatment with oral hypoglycemic medication for ≥ 12 months |
Michiels 2019 [36] | France; HDI = 0.901 | Randomized controlled trial; Randomization at the pharmacy level | 6 months | 174 community pharmacies | Structured and tailored information on diabetes diet, medication management and diabetes complications | 3 interviews | Information on the study by phone, face to face training and a guide explaining how to perform the interviews | T2D, HbA1c level > 7%, with ≤3 different oral antidiabetic drugs |
Mourao 2013 [37] | Brazil; HDI = 0.765 | Randomized controlled trial; Randomization at the patient level | 6 months | 6 primary health care units | Care plan including pharmacotherapy changes if necessary and education about non-pharmacological issues (aetiology, pathophysiology, complications, treatment goals, lifestyle) and pharmacological treatments (proper dosage, side-effects, drug storage) | Monthly | Training in pharmaceutical care and diabetes management | T2D, ≥18 y/o, with post-prandial capillary glucose ≥180 mg/dL and HbA1c ≥ 7 %, under ≥1 oral antidiabetic medications for ≥6 months |
Study | Patients (n) | Mean Age (years) | Mean Baseline HbA1c (%) | Mean Baseline SBP (mmHg) | ||||
---|---|---|---|---|---|---|---|---|
Intervention | Control | Intervention | Control | Intervention | Control | Intervention | Control | |
Ali 2012 [26] | 23 | 23 | 66.4 | 66.8 | 8.2 | 8.1 | 146.3 | 136.2 |
Ayadurai 2018 [27] | 55 | 69 | 55 | 58 | 10.68 | 10.32 | 137 | 137.8 |
Correr 2011 [28] | 50 | 46 | 58.1 | 59.5 | 9.9 | 8.6 | 135 | 147.7 |
Doucette 2009 [29] | 31 | 35 | 58.7 | 61.2 | 7.99 | 7.91 | 118.2 | 119.8 |
Fajriansyah 2020 [30] | 109 | 111 | mean age of both groups: 57.7 | 8.45 | 8.9 | |||
Fornos 2006 [31] | 56 | 56 | 62.4 | 64.9 | 8.4 | 7.8 | 143 | 148 |
Jahangard-Rafsanjani 2014 [32] | 45 | 40 | 57.3 | 55.9 | 7.6 | 7.5 | 132 | 136.4 |
Javaid 2019 [33] | 83 | 52 | 50.3 | 50.4 | 11 | 10.7 | 145 | 133 |
Krass 2007 [34] | 157 | 142 | mean age of both groups: 62 | 8.9 | 8.3 | 135 | 133 | |
Mehuys 2011 [35] | 148 | 132 | 63 | 62.3 | 7.7 | 7.3 | ||
Michiels 2019 [36] | 189 | 188 | 65.1 | 66.3 | 7.9 | 7.7 | 134.4 | 137 |
Mourao 2013 [37] | 50 | 50 | 60 | 61.3 | 9.9 | 9.5 | 152.9 | 140.4 |
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Coutureau, C.; Slimano, F.; Mongaret, C.; Kanagaratnam, L. Impact of Pharmacists-Led Interventions in Primary Care for Adults with Type 2 Diabetes on HbA1c Levels: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2022, 19, 3156. https://doi.org/10.3390/ijerph19063156
Coutureau C, Slimano F, Mongaret C, Kanagaratnam L. Impact of Pharmacists-Led Interventions in Primary Care for Adults with Type 2 Diabetes on HbA1c Levels: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2022; 19(6):3156. https://doi.org/10.3390/ijerph19063156
Chicago/Turabian StyleCoutureau, Claire, Florian Slimano, Céline Mongaret, and Lukshe Kanagaratnam. 2022. "Impact of Pharmacists-Led Interventions in Primary Care for Adults with Type 2 Diabetes on HbA1c Levels: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 19, no. 6: 3156. https://doi.org/10.3390/ijerph19063156