Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis

Bobby Presley; Wim Groot; Milena Pavlova

doi:10.1016/j.sapharm.2018.09.021

Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis

Res Social Adm Pharm. 2019 Sep;15(9):1057-1067. doi: 10.1016/j.sapharm.2018.09.021. Epub 2018 Oct 3.

Authors

Bobby Presley¹, Wim Groot², Milena Pavlova²

Affiliations

¹ Department of Health Services Research (HSR), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; Department of Clinical and Community Pharmacy, Center for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, 60293, Surabaya, East Java, Indonesia. Electronic address: bobbypresley@gmail.com.
² Department of Health Services Research (HSR), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands.

PMID: 30685443
DOI: 10.1016/j.sapharm.2018.09.021

Abstract

Background: Control of blood glucose and a reduced risk of complications are important treatment goals in diabetes. Medication non-adherence can influence the outcome of diabetes. Involvement of a pharmacist in diabetes care might help patients to achieve better treatment outcomes. Existing literature reviews have focused on a limited number of interventions and outcome measures, and have involved different healthcare professionals. None of the previous reviews have used a standardized effect size to compare the effects of different pharmacist-led interventions and different outcome measures.

Objective: To review pharmacist-led interventions to improve medication adherence in patients with diabetes and to assess the effectiveness of these interventions on medication adherence.

Methods: Six databases were systematically searched between March and September 2017 for randomized controlled trials: PubMed, Cochrane library, EMBASE, CINAHL, JSTOR, and Web of Science. The outcome measures used were: medication adherence, HbA1c, fasting plasma glucose (FPG), post-prandial blood glucose (PPG), or random blood glucose (RBG). Cohen's d, a standardized effect size, enabled a comparison of studies with different outcome measures. The Cochrane risk of bias tool was used to assess the quality of the studies.

Results: Fifty-nine studies were included in this review. Pharmacist-led interventions enhanced outcomes in patients with diabetes (standardized mean difference (SMD) -0.68; 95% CI -0.79, -0.58; p < 0.001). Sub-group analysis by intervention strategy, the type of intervention and outcome measures produced similar results. Further analysis showed that education, printed/digital material, training/group discussion, were more effective than other interventions.

Conclusion: This finding supports the role of the pharmacist in diabetes care to enhance medication adherence.

Keywords: Diabetes; Medication adherence; Meta-analysis; Pharmacist; Systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Diabetes Mellitus / drug therapy*
Humans
Medication Adherence*
Pharmacies / organization & administration*
Pharmacists / organization & administration*
Professional Role
Randomized Controlled Trials as Topic