Patient Preference and Adherence (Jan 2023)
Effect of Pharmacist-Led Interventions on Medication Adherence and Glycemic Control in Type 2 Diabetic Patients: A Study from the Chinese Population
Abstract
Mingfen Wu,1 Xiaohan Xu,2 Rongsheng Zhao,2 Xiangrong Bai,3 Bin Zhu,1 Zhigang Zhao1 1Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, People’s Republic of China; 2Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, People’s Republic of China; 3Department of Pharmacy, Xuanwu Hospital Capital Medical University, Beijing, 100053, People’s Republic of ChinaCorrespondence: Zhigang Zhao; Bin Zhu, Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +8601059978036 ; +8601059975444, Fax +8601059976856, Email [email protected]; [email protected]: Medication adherence plays an important role in glycemic control in type 2 diabetes mellitus (T2DM) self-management. To analyze the factors influencing medication adherence in T2DM patients and the effect of pharmacist-led interventions, we conducted a study in Beijing, China.Patients and Methods: T2DM patients with hypoglycemic drugs for at least 6 months were enrolled. A pharmacist-led survey was conducted followed by individualized interventions for those non-adherent patients monthly within 3 months. FPG, HbA1c, and 2hPG were measured as the comprehensive glycemic control. Medication adherence was determined according to the patient’s self-reported compliance with prescribed medication during the last 3 months.Results: A total of 763 T2DM patients were included. The average age was 63.26± 11.89 years, with 363 males. After pharmacist intervention, the patients with good adherence increased from 34.21% to 39.06%, while poor adherence decreased from 32.5% to 24.5% (p < 0.001). The average adherence score was a significant increase (p < 0.001) from 27.846± 4.185 to 29.831± 7.065. Furthermore, our study demonstrated that pharmacist-led interventions significantly increased glycemic control (FPG from 42.33% to 53.60%, p < 0.001; 2hPG from 41.68% to 48.75%, p = 0.005; HbA1c from 24.12% to 29.23%, p = 0.024). The results found that body mass index (OR 0.643, 95% CI 0.437– 0.945), use of medications empirically (occasionally (OR=3.066, 95% CI 2.069– 4.543); often (OR=2.984, 95% CI 1.107– 8.044)), following the doctor’s advice to visit (OR 2.129, 95% CI 1.079– 4.202) and lifestyle compliance (OR 2.835, 95% CI 1.094– 7.346) were the independent risk factors of non-adherence (p < 0.05), the area under the ROC curve was 0.716.Conclusion: Self-reported medication adherence and glycemic control in T2DM patients were poor which can be improved by pharmacist-led interventions. Interventions should focus on empirical medication behavior, non-adherence to lifestyle, and failure to follow the doctor’s advice. The recall bias with self-reported results needs further objective data to verify.Keywords: T2DM, medication adherence, glycemic control, current status, risk factor, pharmacist-led interventions
