The Role of a Clinical Pharmacist in the Management of Type 2 Diabetic Patients in a Primary Medical Center in Jordan

Keywords

• clinical pharmacist
• medical center
• Ministry of Health
• Collaborative approach

Lead sponsor

University of Jordan is the lead sponsor of 126 studies on the registry; 20 are open to participants now.

Study arms

• Other
  the intervention group

  this group received the collaborative care between the clinical pharmacist and physicians in a medical center

  Other: Collaborative approach of clinical pharmacist with physicians in a medical center

• No intervention
  the control group

  this group received the standard care of physicians in a medical center without clinical pharmacist interventions

Interventions

• OtherCollaborative approach of clinical pharmacist with physicians in a medical center

  For those who allocated to the intervention group, the clinical pharmacist interviewed them at each monthly visit about 30 minutes before seeing physicians, the clinical pharmacist identified treatment related problems, provided medication counseling, answered questions asked by patients or physicians, encouraged compliance, offered instructions on self-monitoring of blood pressure and glucose levels, distributed educational materials about diabetes and emphasis was made on optimizing adherence to pharmacological and non- pharmacological therapy. the pharmacist interventions on treatment related problems (TRPs) and proposed patient care plans were discussed with treatng physicians who decided to accept or reject them.

Primary outcomes

1. HbA1c

   Time frame: 3 months

Secondary outcomes

1. Lipid profile

   LDL , HDL , TGS

   Time frame: 3 months

2. Fasting blood glucose

   Time frame: each month for 3 months

3. Patients knowledge about their medications

   Validated questionnaire were used. According to Abu Farha et.al, Patients' medication knowledge was assessed by their ability to answer correctly the questions related to their medication doses, indications and timing. For each correct statement the patient gained 1 point with a total of 3 points for each medication. Patients were considered to have suboptimal knowledge if they obtain an average medication score of 2 or less.

   Time frame: 3 months

4. Cost avoidance of implemented clinical pharmacist interventions

   The cost avoidance of implemented interventions were evaluated relevant to "presumed cost avoidance". This implies an action that reduces or eliminates additional spending that would have happened if the intervention had not occurred. The reduction in costs was estimated using the cost avoidance values that were derived from Campbell. The resulting cost avoidance values for individual clinical pharmacy intervention types are listed below for individual clinical pharmacy intervention type.\* Intervention type, Overall cost avoidance, $ Addition of a medication 62.81 * Change medication 74.67 * Discontinuation of a medication 57.25 * Dosage form change 67.33 * Dose adjustment 71.41 * Drug information 26.97 * Medication reconciliation 472.86 * Monitoring laboratory order 93.58 * Non-formulary consultation 56 * Non-formulary to formulary conversion 44 * Pharmacokinetic monitoring-level adjustment 91.08 * Prevention of adverse drug event 581.08 * Prompted medical follow-up 70.33

   Time frame: 3 months

5. Patients adherence to medications

   Patients' adherence to medications was assessed by Oriana Awwad et al.2022 validated Arabic version of the Morisky, Green, and Levine (MGL) adherence scale \[16\], This scale is "a 4-item instrument used to identify patients with chronic disease who are not taking their medications as prescribed". The scale encloses four questions: 1) "Do you ever forget to take your medicine?" 2) "Are you careless at times about taking your medicine?" 3) "When you feel better do you sometimes stop taking your medicine?" and 4) "Sometimes if you feel worse when you take the medicine, do you stop taking it?" It has a scoring scheme of "Yes" = 1 and "No" = 0 for each item with a total score ranging from 0 to 4. The sum of "Yes" answers provides a composite measure of non-adherence. Lower evaluations imply a higher level of adherence, and total patient scores can be classified into high adherence level (0 answered "yes"), moderate adherence level (1-2 answered "yes") and low level adherence (3-4 "yes").

   Time frame: 3 months

6. Quality of life

   The change in the Quality of Life questionnaire (EQ-5D-5L) was assessed. At baseline, all patients were asked to self-complete the Quality of Life (EQ-5D-5L) questionnaire. This self-completed questionnaire consists of 5 domains" (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression)" in which each dimension is rated with 5 levels of severity (no problems, slight problems, moderate problems, severe problems, and unable to perform or extreme problems). The answers on these domains are translated to give a consequent number; e.g 23445. These numbers have a health utility index score which already had been studied and validated for different population in a number of countries. A single index value for all health states with a range from 0 (where zero is a health state equivalent to death). Another factor express QoL is EQ-vas which is a scale from 0 to 100 where the patients are asked to indicate their overall health on the day after completion of questionnair.

   Time frame: 3 months

7. Blood pressure

   Time frame: 3 months

Individual participant data

Plan to share: Yes