|Year : 2017 | Volume
| Issue : 1 | Page : 7-11
Evaluation of pharmacists' educational and counselling impact on patients' clinical outcomes in a diabetic setting
Winifred Aitalegbe Ojieabu1, Shakirat Iyabo Bello2, John E Arute3
1 Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, Olabisi Onabanjo University, Ago Iwoye, Ogun State, Nigeria
2 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Ilorin, Ilorin, Nigeria
3 Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Delta State University, Abraka, Nigeria
|Date of Web Publication||9-May-2017|
Winifred Aitalegbe Ojieabu
Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, Olabisi Onabanjo University, Ago Iwoye, Ogun State
Source of Support: None, Conflict of Interest: None
Background: Nigeria had the highest number of people living with diabetes mellitus in the African region in year 2013. Previous researchers have found that patients with knowledge of their diseases including their treatment methods have a high likelihood to succeed in managing the disease conditions. Many pharmaceutical care programmes which have been successfully applied in various countries to enhance clinical outcomes and health-related quality of life are not very common in Nigeria. Objective: This study was to evaluate pharmacist's educational and counselling impact on diabetic patients' outcomes in a diabetic setting. Materials and Methods: The 4-month randomised controlled study involved 150 elderly Type 2 diabetic patients. Sociodemographic and clinical parameters were measured. We educated and counselled the 75 patients in our intervention group at least four times during the study period, but the control group was deprived of the pharmacist's intervention. Results: Female to male participants was in the ratio of 9:6 and 9:5 in both control and intervention groups, respectively. Majority (>40%) of the patients in both groups had primary education. Baseline and 4-month mean fasting blood sugar in the control group was 162.2 ± 69.1 and 159.9 ± 57.2, respectively (P = 0.825), whereas the intervention group had 156.7 ± 30.5 and 131.8 ± 40.4, respectively (P < 0.001). Mean systolic blood pressure in both groups was 146.4 ± 13.9 and 133.8 ± 18.5 (P < 0.001), respectively. Adherence levels to medication taking in both groups were 42.7%:94.7%, respectively (P = 0.001). Conclusion: This study encourages the inclusion of clinical pharmacists into multidisciplinary healthcare groups in hospital and clinic settings as well as incorporation of this type of intervention into diabetic management programmes for optimal patients' outcomes.
Keywords: Counselling, diabetes, education, elderly, patients
|How to cite this article:|
Ojieabu WA, Bello SI, Arute JE. Evaluation of pharmacists' educational and counselling impact on patients' clinical outcomes in a diabetic setting. J Diabetol 2017;8:7-11
| Introduction|| |
The WHO projects that by 2030, diabetes mellitus (DM) will become the seventh leading cause of death worldwide. In 2004, the number of people living with diabetes in Africa was put at over 7 million. The region has the highest proportion of undiagnosed diabetes – at least 63%. An estimated 522,600 people in the region died from diabetes-related causes in 2013 representing 8.6% of deaths from all causes in adults. Nigeria had the highest number of people living with DM in the African region in year 2013, as well as estimated highest in year 2035. Diabetes-related deaths in Nigeria were put at 63,340 people in 2011. The chronic hyperglycaemia occurring in diabetic patients is associated with long-term damage, as well as dysfunction and failure of different organs, especially the eyes, kidneys, nerves, heart and blood vessels. Diabetes places an enormous disease burden on patients, as well as on their families and on the society.
Patients with Type 2 diabetes need to be educated and counselled on how to prevent both acute and chronic complications common in diabetes to obtain desired glycaemic control and live improved quality of life. It has been found by previous researchers  that patients with knowledge of their diseases including their treatment methods have high likelihood to succeed in managing the disease conditions. The main objective of this study was to evaluate clinical pharmacists' educational and counselling impact on diabetic patients' outcomes in a diabetic setting.
| Materials and Methods|| |
This was a 4-month randomised controlled study involving a total of 150 elderly Type 2 diabetic patients carried out at the Endocrinology Clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Ogun State, Nigeria. OOUTH is a state government-owned tertiary hospital. The hospital has 241 bed spaces and caters for an average of 974 inpatients and 6486 outpatients monthly. A consultant heads the endocrinology clinic, which holds appointments once weekly. Two final-year pharmacy students trained on data collection procedures assisted the researchers on collection of the needed data. Consented patients who met the inclusion criteria were randomly assigned into both control and intervention groups (75 patients each). Age of older patients was taken as 50 years and above as stated in the WHO definition of old or older persons.
Subject inclusion criteria
Outpatients with a diagnosis of Type 2 DM who have been on hypoglycaemic medication(s) for more than 3 months, receiving medical care from OOUTH for diabetes and who were at least 50 years old during the study period were included in the study.
Subject exclusion criteria
Patients with mental incompetence, acute illness, comorbidities other than hypertension and those who declined participation were excluded from the study.
Baseline assessments and intervention
The clinic holds once a week for diabetic outpatients. Each patient was scheduled to visit the pharmacist at least once a month (on a clinic day). Sociodemographic details of the patients and clinical parameters such as fasting blood sugar (FBS), blood pressure (BP) and body mass index (BMI) were measured. Data were collected at baseline and at the 4th month of the study. All patients received the usual general briefing of about 10–15 min from a coordinating staff on each clinic day. Thereafter, the 75 patients on our intervention group were educated by the pharmacist on diabetes and hypertension, their complications, risks, preventive measures and management. In particular, they were counselled on the need for medication and treatment adherence such as clinic visits and lifestyle modifications including diet and exercise. All patients in the intervention group received phone calls a week before their clinic visit days and a day before each actual visit day. At least four sessions of such interventions were held with each patient by the end of the 4-month intervention study period. The control group, however, was deprived of the pharmacist-led education and counselling sessions throughout the period of the study.
Changes in FBS, BP and BMI.
Responses to questionnaires and other data collected were coded and entered into Microsoft Excel for sorting and Statistical Package for Social Sciences (SPSS) software version 16, (SPSS, Chicago, Illinois, USA) was used for further analysis. Data were analysed using descriptive and comparative analyses. Chi-square and Fisher's exact tests were used for comparison of proportions, whereas Student's t-test was for comparison of means as appropriate. For each patient, BMI was calculated by dividing weight (in kilogram) by height (in meter square). At 95% confidence interval, P ≤ 0.05 was considered statistically significant. Results are presented in mean and in percentage forms.
Ethical approval to carry out the research and to administer questionnaire to the patients was sought and obtained from the Ethics Review Committee of OOUTH before the commencement of the study. Patients' informed consent was designed by the researcher and approved by the Ethical Committee for use in the study.
| Results|| |
A total number of 150 eligible consenting patients participated in this study. Female participants were more than male participants, approximately in the ratio of 9:6 and 9:5 in both control and intervention groups, respectively. Majority of the patients, 42.7% and 46.7%, respectively, in both groups had primary level of education while majority lived on an average monthly income of between N11,000–N20,000. The sociodemographic characteristics of the two groups showed no statistical significant differences [Table 1].
Clinical variables at baseline and 4 months
There was no significant statistical difference between the baseline and 4-month data of the control group as mean FBS was 162.2 ± 69.1 and 159.9 ± 57.2, respectively (P = 0.825). Mean systolic BP (SBP) was 144.7 ± 23.8 and 145.5 ± 18.6, respectively (P = 0.819). There was also no significant statistical change on percentage basis across board. FBS slightly moved from 38.7% at baseline to 42.7% at 4 months, whereas SBP moved from 24.0% to 33.3% (P > 0.05). There were, however, very significant statistical differences between the baseline and 4-month data of the intervention group. The mean FBS being 156.7 ± 30.5 and 131.8 ± 40.4, whereas mean systolic BP was 146.4 ± 13.9 and 133.8 ± 18.5, respectively (P < 0.001). There were also very significant statistical changes on percentage basis across board except with BMI. There was a record of 41.3% and 38.7% increase in both FBS and SBP, respectively at 4 months over baseline values (P < 0.05) [Table 2] and [Table 3].
|Table 3: Clinical variables of intervention group at baseline and 4 months|
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Adherence levels of patients to instructions
Adherence levels significantly improved in the intervention group as compared to the control group as we found medication taking to be 94.7%:42.7% (P = 0.001) and exercise 88.0%:28.0% (P < 0.001), respectively [Table 4].
|Table 4: Adherence level to instructions between intervention and control groups|
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| Discussion|| |
The disease and economic burden diabetes places on its sufferers, communities and nations at large are enormous that all healthcare professionals need to harness their training in the fight against this devastating scourge. Pharmacy services have exceeded the traditional dispensing duties to encompass pharmaceutical care services in the healthcare team. Through the efforts of the clinical pharmacists' educational and counselling sessions, we obtained favourable clinical variables such as FBS level, both systolic and diastolic BP control in the intervention group. These are primary therapeutic goals expected in diabetes management although BMI remained unchanged. A previous study  similarly reported no improvement of BMI although another, however, obtained a contrary result. Earlier studies , revealed that control of hyperglycaemia is important in decreasing the adverse clinical consequences of patients with diabetes. To decrease the risk associated with the development of cardiovascular diseases, target BP should be aimed at in both hypertensive and diabetic patient management. Some earlier studies found that clinical pharmacy services could improve health outcomes as well as reduce the economic costs of patients with diabetes., The improved clinical variables clearly indicate the benefits of including pharmacists into consultation teams in hospital settings. Clinical pharmacists could employ patient education and counselling as two important non-pharmacological intervention methods to bring about patient positive health outcomes. This is what we have proved in this study. Patients' education is of essence in achieving optimal treatment outcome in diabetes management. This is because education can influence knowledge that could empower patients to rise up and be effectively involved in the management of their health. Patients' understanding of their disease conditions, blood glucose monitoring and lifestyle modifications could be factored into patient education and counselling to optimise diabetes management outcomes. According to earlier investigators,, effective patient education that creates room for patients' participation could lead to better self-management of their disease as well as improved patient adherence. It has been reported that in most intervention programmes used in Type 2 diabetes management, those with combination of exercise, dietary advice and behavioural modificcations have registered the most noticeable successes.,
The close professional relationship built between the patient and the clinical pharmacist educator could have contributed significantly to our appreciable results as asserted by a previous report  who found consultation with pharmacist during patients' visits resulted into an improved glycaemic control programme. Previous investigators , found the long-term maintenance of these obtained positive changes could be very difficult. Therefore, there is a need to put in place effective continuous follow-up strategies to sustain the recorded positive health changes in this study for the benefit of patients, healthcare professionals and healthcare facilities.
| Conclusion|| |
The pharmacists' expanded roles in the healthcare sectors are openings to perform relevant clinical functions for the patient's better outcomes. In chronic disease management such as in DM, patient education and counselling have become key tools in patients' self-successful management programmes because of their high effectiveness in achieving both glycaemic and BP controls including a reduction in their overall complications. Thus, the findings in this study are in agreement with earlier ones which demonstrated that clinical pharmacists are effective in the management of chronic diseases such as diabetes. This study encourages the inclusion of clinical pharmacists into multidisciplinary healthcare groups in hospital and clinic settings as well as incorporation of this type of intervention into diabetic management programmes for optimal patients' outcomes.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]