Impact of pharmacotherapeutic education on medication adherence and adverse outcomes in patients with type 2 diabetes mellitus: a prospective, randomized study

Srećko Marušić, Petra Meliš, Marko Lucijanić, Ivica Grgurević, Petra Turčić, Paulo Roque Obreli Neto, Ines Bilić-Ćurčić, Srećko Marušić, Petra Meliš, Marko Lucijanić, Ivica Grgurević, Petra Turčić, Paulo Roque Obreli Neto, Ines Bilić-Ćurčić

Abstract

Aim: To evaluate the impact of pharmacotherapeutic education on 30-day post-discharge medication adherence and adverse outcomes in patients with type 2 diabetes mellitus (T2DM).

Methods: The prospective, randomized, single-center study was conducted at the Medical Department of University Hospital Dubrava, Zagreb, between April and June 2018. One hundred and thirty adult patients with T2DM who were discharged to the community were randomly assigned to either the intervention or the control group. Both groups during the hospital stay received the usual diabetes education. The intervention group received additional individual pre-discharge pharmacotherapeutic education about the discharge prescriptions. Medication adherence and occurrence of adverse outcomes (adverse drug reactions, readmission, emergency department visits, and death) were assessed at the follow-up visit, 30 days after discharge.

Results: The number of adherent patients was significantly higher in the intervention group (57/64 [89.9%] vs 41/61 [67.2%]; χ2 test, P=0.003]. There was no significant difference between the groups in the number of patients who experienced adverse outcomes (31/64 [48.4%] vs 36/61 [59.0%]; χ2 test, P=0.236). However, higher frequencies of all adverse outcomes were consistently observed in the control group.

Conclusion: Pharmacotherapeutic education of patients with T2DM can significantly improve 30-day post-discharge medication adherence, without a significant reduction in adverse clinical outcomes. ClinicalTrial.gov identification number: NCT03438162.

Figures

Figure 1
Figure 1
Study flow-chart.

References

    1. Cho NH; IDF Diabetes Atlas Committee, editor. IDF Diabetes Atlas, seventh edition. Karakas print; 2015. Available from: https://. Accessed: February 12, 2018.
    1. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38:140–9. doi: 10.2337/dc14-2441.
    1. McCracken R, McCormack J, McGregor MJ, Wong ST, Garrison S. Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada. BMJ Open. 2017;7:e017430. doi: 10.1136/bmjopen-2017-017430.
    1. Singh A, Dwivedi S. Study of adverse drug reactions in patients with diabetes attending a tertiary care hospital in New Delhi, India. Indian J Med Res. 2017;145:247–9.
    1. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–7. doi: 10.7326/0003-4819-138-3-200302040-00007.
    1. Leporini C, Piro R, Ursini F, Maida F, Palleria C, Arturi F, et al. Monitoring safety and use of old and new treatment options for type 2 diabetic patients: a two-year (2013-2016) analysis. Expert Opin Drug Saf. 2016;15:17–34. doi: 10.1080/14740338.2016.1246531.
    1. Thomsen LA, Winterstein AG, Sondergaard B, Haugbolle LS, Melander A. Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care. Ann Pharmacother. 2007;41:1411–26. doi: 10.1345/aph.1H658.
    1. Aikens JE, Piette JD. Longitudinal association between medication adherence and glycaemic control in Type 2 diabetes. Diabet Med. 2013;30:338–44. doi: 10.1111/dme.12046.
    1. Capoccia K, Odegard PS, Letassy N. Medication adherence with diabetes medication: a systematic review of the literature. Diabetes Educ. 2016;42:34–71. doi: 10.1177/0145721715619038.
    1. Odegard PS, Capoccia K. Medication taking and diabetes: a systematic review of the literature. Diabetes Educ. 2007;33:1014–29. doi: 10.1177/0145721707308407.
    1. Odegard PS, Gray SL. Barriers to medication adherence in poorly controlled diabetes mellitus. Diabetes Educ. 2008;34:692–7. doi: 10.1177/0145721708320558.
    1. Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: paying for coordinated quality care. JAMA. 2011;306:1794–5. doi: 10.1001/jama.2011.1561.
    1. Ostling S, Wyckoff J, Ciarkowski SL, Pai CW, Choe HM, Bahl V, et al. The relationship between diabetes mellitus and 30-day readmission rates. Clin Diabetes Endocrinol. 2017;3:3. doi: 10.1186/s40842-016-0040-x.
    1. Rubin DJ. Hospital readmission of patients with diabetes. Curr Diab Rep. 2015;15:17. doi: 10.1007/s11892-015-0584-7.
    1. Davies EC, Green CF, Mottram DR, Rowe PH, Pirmohamed M. Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. Br J Clin Pharmacol. 2010;70:749–55. doi: 10.1111/j.1365-2125.2010.03751.x.
    1. Aldardeer N, Benslimane N, Khalifa M. Medications Related Emergency Admissions: Causes and Recommendations. Stud Health Technol Inform. 2017;238:169–72.
    1. Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ. 2008;178:1563–9. doi: 10.1503/cmaj.071594.
    1. Sullivan SD, Dalal MR, Burke JP. The impact of diabetes counseling and education: clinical and cost outcomes from a large population of US managed care patients with type 2 diabetes. Diabetes Educ. 2013;39:523–31. doi: 10.1177/0145721713486525.
    1. Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166:565–71. doi: 10.1001/archinte.166.5.565.
    1. Schulz KF, Altman DG, Moher D. CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332. doi: 10.1136/bmj.c332.
    1. Marusic S, Gojo-Tomic N, Erdeljic V, Bacic-Vrca V, Franic M, Kirin M, et al. The effect of pharmacotherapeutic counseling on readmissions and emergency department visits. Int J Clin Pharm. 2013;35:37–44. doi: 10.1007/s11096-012-9700-9.
    1. Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999;21:1074–90. doi: 10.1016/S0149-2918(99)80026-5.
    1. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45. doi: 10.1038/clpt.1981.154.
    1. Obreli-Neto PR, Guidoni CM, de Oliveira Baldoni A, Pilger D, Cruciol-Souza JM, Gaeti-Franco WP, et al. Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients. Int J Clin Pharm. 2011;33:642–9. doi: 10.1007/s11096-011-9518-x.
    1. Xin C, Xia Z, Jiang C, Lin M, Li G. Effect of pharmaceutical care on medication adherence of patients newly prescribed insulin therapy: a randomized controlled study. Patient Prefer Adherence. 2015;9:797–802. doi: 10.2147/PPA.S84411.
    1. Asche C, LaFleur J, Conner C. A review of diabetes treatment adherence and the association with clinical and economic outcomes. Clin Ther. 2011;33:74–109. doi: 10.1016/j.clinthera.2011.01.019.
    1. Khunti K, Seidu S, Kunutsor S, Davies M. Association between adherence to pharmacotherapy and outcomes in type 2 diabetes: a meta-analysis. Diabetes Care. 2017;40:1588–96. doi: 10.2337/dc16-1925.
    1. Kuo YF, Raji MA, Markides KS, Ray LA, Espino DV, Goodwin JS. Inconsistent use of diabetes medications, diabetes complications, and mortality in older Mexican Americans over a 7-year period: data from the Hispanic established population for the epidemiologic study of the elderly. Diabetes Care. 2003;26:3054–60. doi: 10.2337/diacare.26.11.3054.
    1. Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166:1836–41. doi: 10.1001/archinte.166.17.1836.
    1. Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166:565–71. doi: 10.1001/archinte.166.5.565.
    1. McDowell J, Boyd E. Community diabetes nurse specialists: service evaluation to describe their professional role. Br J Community Nurs. 2018;23:426–34. doi: 10.12968/bjcn.2018.23.9.426.
    1. Sarayani A, Mashayekhi M, Nosrati M, Jahangard-Rafsanjani Z, Javadi M, Saadat N, et al. Efficacy of a telephone-based intervention among patients with type-2 diabetes; a randomized controlled trial in pharmacy practice. Int J Clin Pharm. 2018;40:345–53. doi: 10.1007/s11096-018-0593-0.
    1. Curtis SE, Boye KS, Lage MJ, Garcia-Perez LE. Medication adherence and improved outcomes among patients with type 2 diabetes. Am J Manag Care. 2017;23:e208–14.

Source: PubMed

3
Subscribe