Evaluation Of Pharmacist-Led Homebased Intervention Among Type 2 Diabetes Patients From A Public Primary Care Centre At Bukit Minyak, Penang Malaysia
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Date
2015-09
Authors
EE PIN, CHOW
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Abstract
Diabetes mellitus is one of the most common non-communicable diseases in
the world. Type 2 diabetes mellitus account for 90-95% of the diabetes population.
Uncontrolled type 2 diabetes has severe complications. In Malaysia, within four
years there was an increase of 3.6% of adults aged > 18 had diabetes mellitus. Type 2
diabetes mellitus required continuous care management, however in most cases there
is a lost of continuity of care in type 2 diabetes mellitus patients once they left the
healthcare facilities. Studies have shown a high incidence of drug-related problems
among patients who had discharged from healthcare facilities. Thus, this study was
to evaluate the impact of pharmacist-led home-based intervention among type 2
diabetes patients at Bukit Minyak clinic in Penang, Malaysia. This was a randomised
controlled trial conducted in Bukit Minyak clinic. Patients aged 18 years and above
and diagnosed with T2DM with the most recent HbA1c >6.5%, currently taking
three or more long term medications for diabetes, hypertension or hyperlipidaemia,
staying at house with permanent residential address and telephone number, able to
understand Bahasa Malaysia, English or Chinese and willing to participate were
recruited. Patients who were agreed to participate in the study were assigned to either
the intervention group [(IG), which consisted a two home visits by the pharmacist] or
control group [(CG) where no home visit was provided] using a coin tossing. Patients
in the intervention group received educational sessions, medication review and point
of care for blood pressure, cholesterol and sugar monitoring during the home visits.
There was no intervention given to the control group. Patients in both groups were
assessed on their medication adherence and knowledge using the validated MMAS-8
and MDKT questionnaire during the enrolment and final assessment for the control
group and 2nd home visit for the intervention group. In general, patients in both
groups had low medication adherence and poor knowledge on diabetes. However,
after the home-based intervention, patients in the intervention group had significant
improvement in HbA1c (-0.73 ± 1.50), diastolic blood pressure (-1.19 ± 9.96), total
cholesterol (-0.45 ± 1.16), triglyceride (-0.14 ± 0.48), medication adherence score
(3.37 ± 1.67) and knowledge score (5.84 ± 1.90) compared to the control group, p <
0.05. A total of 202 drug related problems identified during the first visit with an
average of (3.37 ± 2.99) DRP per visited patient. Forty eight out of 60 patients (80%)
have at least one DRP. From the excessive medications collected, a total cost of RM
2805.50 (USD 770.38) with an average of RM 47.55 (USD 13.06) per patient was
calculated from 59 patients. Metformin was the drug with most excess quantities in
patient’s house. This study had indicated that pharmacist-led home-based
intervention is able to improve patients’ medication adherence, knowledge and
clinical outcomes.
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Evaluation Of Pharmacist-Led Homebased Intervention Among Type 2 Diabetes Patients , From A Public Primary Care Centre At Bukit Minyak, Penang Malaysia