Pharmacist-led intervention to improve treatment outcomes in type 2 diabetes: a randomized controlled trial

Abstract

Pharmacists’ contribution to medication therapy management in type 2 diabetes (T2D) is under-reported in Nigeria. This study evaluated the effectiveness of a pharmacy-based intervention on knowledge, pharmacy refills, medication adherence, and glycemic control among patients with T2D. A two-arm prospective, randomized, controlled trial among 309 T2D patients over 25 weeks duration was conducted in a tertiary hospital. The intervention group (n = 155) received weekly health education and follow-up sent as phone-based short message service (SMS), alongside standard care. Control group (n = 154) received only standard care. Primary (HbA1c reduction) and secondary (refill adherence, knowledge, and medication adherence) outcomes were assessed and compared in both groups at baseline and endline. Intervention improved glycemic control (HbA1c reduction) directly (t = 8.253, P < .001) and indirectly through improved pharmacy refill adherence as 115 (76%) of the intervention group were refill adherent (Proportion of Days Covered [PDC] > 80%). For controls, mean baseline and endline knowledge scores were 2.798 and 2.816, respectively (t = 1.19092, P > .005), while the intervention group had 2.732 and 4.462, respectively (t = 9.76157, P < .005) on a 5-point Likert scale. Baseline and endline adherence scores for control group were 3.41 and 3.50, respectively (t = 0.92477, P > .05), while the intervention group had 3.35 and 6.72, respectively (t = 17.87981, P < .05) on the 8-point Morisky Medication Adherence Scale (MMAS-8). Pharmacist-led intervention significantly improved medication refills, glycemic control, knowledge, and medication adherence. Pharmacists should exploit mobile telephony for health education and follow-up services to improve treatment outcomes in medication therapy management of T2D.