Evaluation of home medication review for patients with type 2 diabetes mellitus by community pharmacists: a randomised controlled trial

M Rozaini Rosli; Chin F Neoh; David B Wu; Nazariah W Hassan; Mahani Mahmud; Afifah Rahimi; Mahmathi Karuppannan

doi:10.18549/PharmPract.2021.3.2397

Evaluation of home medication review for patients with type 2 diabetes mellitus by community pharmacists: a randomised controlled trial

Pharm Pract (Granada). 2021 Jul-Sep;19(3):2397. doi: 10.18549/PharmPract.2021.3.2397. Epub 2021 Sep 9.

Authors

M Rozaini Rosli¹, Chin F Neoh², David B Wu³, Nazariah W Hassan⁴, Mahani Mahmud⁵, Afifah Rahimi⁶, Mahmathi Karuppannan⁷

Affiliations

¹ BPharm, MBA. PhD. Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia). zaini_0601@yahoo.com.
² PhD. Senior Lecturer. Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia). chinfenneoh@gmail.com.
³ PhD. Director. Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-Being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Sunway Town, Selangor (Malaysia). david.wu@monash.edu.
⁴ M.D. Family medicine specialist, Pasir Mas City Health Clinic. Kelantan (Malaysia). drnazariah@moh.gov.my.
⁵ M.D. Senior Medical Officer at Pasir Mas City Health Clinic, Hospital Street, Pasir Mas, Kelantan, Malaysia. drmahani@moh.gov.my.
⁶ BPharm. Senior Pharmacist at Pasir Mas City Health Clinic, Hospital Street, Pasir Mas, Kelantan, Malaysia. afifahrahimi@moh.gov.my.
⁷ PhD. Senior Lecturer, Faculty of Pharmacy, University of Technology MARA (UiTM). Selangor (Malaysia). mahmathi@uitm.edu.my.

Abstract

Background: Successful diabetes treatment requires commitment and understanding of disease management by the patients.

Objective: This trial aimed to evaluate the programme effectiveness of home medication review by community pharmacists (HMR-CP) in optimising diabetes care and reducing medication wastage.

Methods: A randomised controlled trial was conducted on 166 patients with Type 2 Diabetes Mellitus (T2DM) who were randomly assigned to the intervention or control groups. The intervention group received HMR-CP at 0-month, 3-month, and 6-month. The primary outcome was haemoglobin A1c (HbA1c) while clinical outcomes, anthropometric data, and humanistic outcomes were the secondary outcomes. For the intervention group, drug-related problems (DRP) were classified according to the Pharmaceutical Care Network Europe Foundation (PCNE). Medication adherence was determined based on the Pill Counting Adherence Ratio (PCAR). The cost of medication wastage was calculated based on the total missed dose by the T2DM patients multiplied by the cost of medication. General linear model and generalised estimating equations were used to compare data across the different time-points within and between the groups, respectively.

Results: No significant difference was observed in the demographic and anthropometric data at baseline between the two groups except for fasting blood glucose (FBG). There was a significant reduction in the HbA1c (-0.91%) and FBG (-1.62mmol/L) over the study period (p<0.05). A similar observation was noted in diastolic blood pressure (DBP) and total cholesterol (TC) but not in high-density lipoprotein (HDL), and anthropometric parameters. Both utility value and Michigan Diabetes Knowledge Test (MDKT) scores increased significantly over time. As for the intervention group, significant changes in PCAR (p<0.001) and the number of DRP (p<0.001) were noted.

Conclusions: HMR-CP significantly improved the glycaemic control, QoL, medication adherence, and knowledge of T2DM patients as well as reduced the number of DRP and cost of medication wastage. However, the impact of HMR-CP on certain clinical and anthropometric parameters remains inconclusive and further investigation is warranted.

Keywords: Blood Glucose; Diabetes Mellitus, Type 2; Disease Management; Glycated Hemoglobin A; Glycemic Control; Linear Models; Malaysia; Medication Adherence; Pharmaceutical Services; Pharmacists; Program Evaluation; Randomized Controlled Trials as Topic.