TY - JOUR
T1 - Pharmaceutical care of elderly patients with poorly controlled type 2 diabetes mellitus
T2 - a randomized controlled trial
AU - Chen, Jyun Hong
AU - Ou, Huang Tz
AU - Lin, Tzu Chieh
AU - Lai, Edward Chia Cheng
AU - Yang Kao, Yea Huei
N1 - Funding Information:
From the third-party payer perspective, we estimated the expenditure for pharmacist intervention for both groups (Table ). All expenditures in the study project were funded by the Department of Health, Executive Yuan, ROC. The mean reduction in HbA1c levels achieved by pharmaceutical care compared with that of standard care was approximately 0.83 %. The mean cost per patient in the intervention group was NTD 1336.9 versus NTD 132 in the control group. This represented an increase in cost of NTD 1204.9 per patient. The net cost and the net effectiveness of the intervention group compared with the control group were calculated and expressed as a cost-effectiveness ratio (the additional cost per benefit gained). Thus, the incremental cost per 1 % reduction in the mean HbA1c level for pharmaceutical care compared with standard care was NTD 1451.69. From the hospital manager’s perspective, if patients were satisfied with their health outcomes (decrease in HbA1c level or absence of adverse drug events) achieved by the pharmacist-involved diabetes care team, they may increase their follow-up visits. Because the P4P program provides financial incentives for hospitals for patients’ complete follow-up, the hospital would receive more payment points from health insurance reimbursement, decreasing the additional pharmaceutical care service costs.
Funding Information:
This study was supported by a Grant from the Department of Health, Executive Yuan, Taiwan (ROC) (100-MID-08).
Publisher Copyright:
© 2015, Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background Care of the elderly with diabetes is more complicated than that for other age groups. The elderly and/or those with multiple comorbidities are often excluded from randomized controlled trials of treatments for diabetes. The heterogeneity of health status of the elderly also increases the difficulty in diabetes care; therefore, diabetes care for the elderly should be individualized. Motivated patients educated about diabetes benefit the most from collaborating with a multidisciplinary patient-care team. A pharmacist is an important team member by serving as an educator, coach, healthcare manager, and pharmaceutical care provider. Objective To evaluate the effects of pharmaceutical care on glycemic control of ambulatory elderly patients with type 2 diabetes. Setting A 421-bed district hospital in Nantou City, Taiwan. Method We conducted a randomized controlled clinical trial involving 100 patients with type 2 diabetes with poor glycemic control (HbA1c levels of ≥9.0 %) aged ≥65 years over 6 months. Participants were randomly assigned to a standard-care (control, n = 50) or pharmaceutical-care (intervention, n = 50) group. Pharmaceutical care was provided by a certified diabetes-educator pharmacist who identified and resolved drug-related problems and established a procedure for consultations pertaining to medication. The Mann–Whitney test was used to evaluate nonparametric quantitative data. Statistical significance was defined as P < 0.05. Main outcome measure The change in the mean HbA1c level from the baseline to the next level within 6 months after recruiting. Results Nonparametric data (Mann–Whitney test) showed that the mean HbA1c level significantly decreased (0.83 %) after 6 months for the intervention group compared with an increase of 0.43 % for the control group (P ≤ 0.001). Medical expenses between groups did not significantly differ (−624.06 vs. −418.7, P = 0.767). There was no significant difference in hospitalization rates between groups. Conclusion The pharmacist intervention program provided pharmaceutical services that improved long-term, safe control of blood sugar levels for ambulatory elderly patients with diabetes and did not increase medical expenses.
AB - Background Care of the elderly with diabetes is more complicated than that for other age groups. The elderly and/or those with multiple comorbidities are often excluded from randomized controlled trials of treatments for diabetes. The heterogeneity of health status of the elderly also increases the difficulty in diabetes care; therefore, diabetes care for the elderly should be individualized. Motivated patients educated about diabetes benefit the most from collaborating with a multidisciplinary patient-care team. A pharmacist is an important team member by serving as an educator, coach, healthcare manager, and pharmaceutical care provider. Objective To evaluate the effects of pharmaceutical care on glycemic control of ambulatory elderly patients with type 2 diabetes. Setting A 421-bed district hospital in Nantou City, Taiwan. Method We conducted a randomized controlled clinical trial involving 100 patients with type 2 diabetes with poor glycemic control (HbA1c levels of ≥9.0 %) aged ≥65 years over 6 months. Participants were randomly assigned to a standard-care (control, n = 50) or pharmaceutical-care (intervention, n = 50) group. Pharmaceutical care was provided by a certified diabetes-educator pharmacist who identified and resolved drug-related problems and established a procedure for consultations pertaining to medication. The Mann–Whitney test was used to evaluate nonparametric quantitative data. Statistical significance was defined as P < 0.05. Main outcome measure The change in the mean HbA1c level from the baseline to the next level within 6 months after recruiting. Results Nonparametric data (Mann–Whitney test) showed that the mean HbA1c level significantly decreased (0.83 %) after 6 months for the intervention group compared with an increase of 0.43 % for the control group (P ≤ 0.001). Medical expenses between groups did not significantly differ (−624.06 vs. −418.7, P = 0.767). There was no significant difference in hospitalization rates between groups. Conclusion The pharmacist intervention program provided pharmaceutical services that improved long-term, safe control of blood sugar levels for ambulatory elderly patients with diabetes and did not increase medical expenses.
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U2 - 10.1007/s11096-015-0210-4
DO - 10.1007/s11096-015-0210-4
M3 - Article
C2 - 26499503
AN - SCOPUS:84956614028
VL - 38
SP - 88
EP - 95
JO - Pharmaceutisch Weekblad - Scientific Edition
JF - Pharmaceutisch Weekblad - Scientific Edition
SN - 2210-7703
IS - 1
ER -