Pharmacist-led intervention to improve treatment outcomes in type 2 diabetes: a randomized controlled trial

Abstract

Objectives: Pharmacists’ contribution to medication therapy management in type 2 diabetes (T2D) is under-reported in Nigeria. This study evaluated the effectiveness of a pharmacy-based intervention on knowledge, pharmacy refills, medication adherence, and glycemic control among patients with T2D. Methods: A two-arm prospective, randomized, controlled trial among 309 T2D patients over 25 weeks duration was conducted in a tertiary hospital. The intervention group (n = 155) received weekly health education and follow-up sent as phone-based short message service (SMS), alongside standard care. Control group (n = 154) received only standard care. Primary (HbA1c reduction) and secondary (refill adherence, knowledge, and medication adherence) outcomes were assessed and compared in both groups at baseline and endline. Key findings: Intervention improved glycemic control (HbA1c reduction) directly (t = 8.253, P < .001) and indirectly through improved pharmacy refill adherence as 115 (76%) of the intervention group were refill adherent (Proportion of Days Covered [PDC] > 80%). For controls, mean baseline and endline knowledge scores were 2.798 and 2.816, respectively (t = 1.19092, P > .005), while the intervention group had 2.732 and 4.462, respectively (t = 9.76157, P.05), while the intervention group had 3.35 and 6.72, respectively (t = 17.87981, P < .05) on the 8-point Morisky Medication Adherence Scale (MMAS-8). Conclusion: Pharmacist-led intervention significantly improved medication refills, glycemic control, knowledge, and medication adherence. Pharmacists should exploit mobile telephony for health education and follow-up services to improve treatment outcomes in medication therapy management of T2D.