Effects of a pharmacotherapy follow-up in community pharmacies on type 2 diabetes patients in Brazil

Abstract

Objective To evaluate the effects of pharmacotherapy follow-up (PF) on metabolic control and clinical outcomes in type 2 diabetic patients. Setting Six community pharmacies (4 intervention and 2 control) in the Curitiba metropolitan region (Brazil). Main outcome measure Glycosylated Haemoglobin A1 (HbA1) and fasting capillary glycaemia. Methods We conducted a 12-month controlled trial involving a total of 161 patients in six community pharmacies between July 2004 and March 2006. Pharmacotherapy follow-up was applied only to patients in the intervention group. Results Of the 161 patients enrolled, 96 completed the study (50 intervention and 46 control). The administration of 574 consultations with the intervention group patients led to 119 negative clinical outcomes (2.3/patient [SD = 1.6]). The majority of detected problems were related to the ineffectiveness of pharmacotherapy (68.1%). Relative to the control group, the intervention group exhibited greater glycosylated haemoglobin (HbA1) reduction (-2.2% [95%CI -2.8%:-1.6%] vs. -0.3 [95% CI -0.8:0.2]; P\0.001) and greater fasting capillary glycaemia reduction (-20.1 mg/dl [95% CI -31.9 mg/dl:-8.3 mg/dl] vs. 4.3 mg/dl [95% CI -13.4 mg/dl:22.2 mg/dl]; P =0.022). These differences persisted after adjustment for baseline values. There were no significant differences in any other clinical measures between the groups. There were also no significant changes in the number of medications and treatment regimens between groups, with the exception of the percentage of patients undergoing lipid lowering treatment, which increased in the intervention group from 16% to 24% (P = 0.018). The initial medication regimen complexity index (MRCI) in the intervention group was 15.5 (SD = 7.8, range 4–40.5), and it decreased by 1.2 units (SD = 5.9) after 12 months (P = 0.149). Conclusions PF of type 2 diabetic patients in community pharmacies can improve the glycaemia control of patients through optimisation of medication profiles without significant changes in either the number of drugs used or the regimen complexity.