Effects of a pharmacotherapy follow-up in community pharmacies on type 2 diabetes patients in Brazil

Int J Clin Pharm. 2011 Apr;33(2):273-80. doi: 10.1007/s11096-011-9493-2. Epub 2011 Mar 12.

Abstract

Objective: To evaluate the effects of pharmacotherapy follow-up (PF) on metabolic control and clinical outcomes in type 2 diabetic patients.

Setting: Six community pharmacies (4 intervention and 2 control) in the Curitiba metropolitan region (Brazil).

Main outcome measure: Glycosylated Haemoglobin A1 (HbA1) and fasting capillary glycaemia.

Methods: We conducted a 12-month controlled trial involving a total of 161 patients in six community pharmacies between July 2004 and March 2006. Pharmacotherapy follow-up was applied only to patients in the intervention group.

Results: Of the 161 patients enrolled, 96 completed the study (50 intervention and 46 control). The administration of 574 consultations with the intervention group patients led to 119 negative clinical outcomes (2.3/patient [SD = 1.6]). The majority of detected problems were related to the ineffectiveness of pharmacotherapy (68.1%). Relative to the control group, the intervention group exhibited greater glycosylated haemoglobin (HbA1) reduction (-2.2% [95%CI -2.8%:-1.6%] vs. -0.3 [95% CI -0.8:0.2]; P < 0.001) and greater fasting capillary glycaemia reduction (-20.1 mg/dl [95% CI -31.9 mg/dl:-8.3 mg/dl] vs. 4.3 mg/dl [95% CI -13.4 mg/dl:22.2 mg/dl]; P = 0.022). These differences persisted after adjustment for baseline values. There were no significant differences in any other clinical measures between the groups. There were also no significant changes in the number of medications and treatment regimens between groups, with the exception of the percentage of patients undergoing lipid lowering treatment, which increased in the intervention group from 16% to 24% (P = 0.018). The initial medication regimen complexity index (MRCI) in the intervention group was 15.5 (SD = 7.8, range 4-40.5), and it decreased by 1.2 units (SD = 5.9) after 12 months (P = 0.149).

Conclusions: PF of type 2 diabetic patients in community pharmacies can improve the glycaemia control of patients through optimisation of medication profiles without significant changes in either the number of drugs used or the regimen complexity.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Aged
  • Biomarkers / blood
  • Blood Glucose / drug effects
  • Brazil
  • Chi-Square Distribution
  • Community Pharmacy Services*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Linear Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Pharmacies*
  • Pharmacists*
  • Professional Role
  • Time Factors
  • Treatment Outcome

Substances

  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human