A Review of Advances in Collaborative Pharmacy Practice to Improve Adherence to Standards of Care in Diabetes Management

Abstract Objectives An insulinoma is an insulin-secreting neuroendocrine tumor of the pancreas. This rare tumor induces severe hypoglycemia and is often resolved through total or near-total pancreatectomy (TP). With the removal of the pancreas, patients lose their insulin and glucagon function, thus inducing a Type 1 diabetic state with complete dependence on insulin replacement therapy. This diabetes type is known as Type 3c or pancreatogenic diabetes. Methods The patient was a 58-year-old female that presented with severe hypoglycemia (fasting blood glucose (FBG) 20–30 mg/dL). She was diagnosed with an insulinoma and underwent a near-TP. After surgery, she was diagnosed with new-onset Type 1 Diabetes Mellitus (T1DM) with FBG 137–207 mg/dL. The nutrition diagnosis was food- and nutrition-related knowledge deficit related to lack of exposure to information as evidenced by new diagnosis of insulin dependent diabetes secondary to near-TP. She began insulin therapy along with education on diabetes management using dietary approaches. She will be monitored for malabsorption from pancreatic insufficiency. An interdisciplinary approach was used for treatment including a registered dietitian, endocrinologist, diabetes educator, and primary care physician. Results The literature on pancreatogenic diabetes treatment is scarce. Current American Diabetes Association standards of care do not set specific glycemic targets for Type 3c. Cases are treated as T1DM due to the reliance on exogenous insulin, yet there are some differences owing to the insufficiency of digestive enzymes and glucagon unique to Type 3c (e.g., patients may be more vulnerable to hypoglycemia). A multidisciplinary approach to bridge the patient's knowledge gap was used for disease management. Conclusions An insulinoma induces severe hypoglycemia, while its treatment induces diabetes. In the absence of evidence-based guidelines, the clinical course and treatment is similar to that of T1DM due to the dependence on exogenous insulin. Thus, a multidisciplinary approach with focus on dietary strategies to manage glucose was used treat the disease. More research on the differences between Type 3c and T1DM and its subsequent treatment is necessary to minimize risk of chronic micro- and macro-vascular complications and hypoglycemia. Funding Sources NA.

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Treatment of Type 2 Diabetes in Primary Health Care: A Drug Utilization Study

Annals of Pharmacotherapy ◽

10.1345/aph.1e273 ◽

2005 ◽

Vol 39 (3) ◽

pp. 441-445 ◽

Cited By ~ 7

Author(s):

Dolores Mino-León ◽

Albert Figueras ◽

Dante Amato ◽

Joan-Ramon Laporte

Keyword(s):

Type 2 Diabetes ◽

Metabolic Control ◽

Medical Record ◽

Drug Utilization ◽

Diabetes Management ◽

Patient Adherence ◽

Glycosylated Hemoglobin ◽

Standards Of Care ◽

Drug Utilization Study

BACKGROUND: Metabolic control in type 2 diabetes depends on patient adherence to therapy. Quantitative consumption data do not supply information regarding the appropriate use of medicine. Drug utilization studies are useful to identify treatment adherence problems and, thus, design interventions to improve drug use. OBJECTIVE: To describe the treatment and outcome in terms of degree of metabolic control in these patients, assess the agreement between the doses of antidiabetic drugs reported by the patient and those written in the medical record, and describe the drug utilization characteristics in relation to the standards of care. METHODS: This drug utilization study was conducted in primary care centers in Barcelona, Spain. Consecutive patients with type 2 diabetes attending a follow-up visit were interviewed regarding lifestyle, diet, glycosylated hemoglobin level, and treatment. Concordance between the information obtained through medical records and patient interviews was analyzed. RESULTS: Metabolic control was deficient in 73 (40%), acceptable in 50 (28%), and good in 58 (32%) of the 181 patients with available information. For 38 (19%) patients, there was disagreement between the dose of the antidiabetic drug reported by the patient and that written in the medical record. For 83 (41%) patients, the treatment in the medical history was in agreement with published standards. CONCLUSIONS: Identification of disagreement between standards of care and clinical practice in type 2 diabetes management is the basis to improve drug utilization and achieve better metabolic control in these patients.

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Providing Standards for Diabetes Care in the School Setting: A Review of the Colorado Model

NASN School Nurse ◽

10.1177/1942602x17725886 ◽

2017 ◽

Vol 33 (1) ◽

pp. 52-56 ◽

Cited By ~ 1

Author(s):

Kathleen Ann Patrick ◽

Leah Wyckoff

Keyword(s):

Diabetes Care ◽

Diabetes Management ◽

School Setting ◽

School Nurses ◽

Standards Of Care ◽

New Approaches ◽

Care Practices

In 2013, a collaboration of organizations in Colorado developed a set of standards to address school nurses’ need for current diabetes care practices in the school setting. The Standards of Care for Diabetes Management in the School Setting are successful in meeting the needs of the school nurses in Colorado and are updated annually to continue to provide valid guidelines as diabetes care continues to become more technological and new approaches are adopted. A review of the standards, including background, development, contents, evaluations, and ongoing additions, is provided in this article.

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What Gets Measured Gets Improved—Setting Standards and Accreditation for Quality Improvement for Diabetes Services in Australia

Journal of Diabetes Science and Technology ◽

10.1177/19322968211009910 ◽

2021 ◽

pp. 193229682110099

Author(s):

Sofianos Andrikopoulos ◽

Steven James ◽

Natalie Wischer

Keyword(s):

Quality Improvement ◽

Diabetes Care ◽

Diabetes Management ◽

National Level ◽

National Policy ◽

Accreditation Process ◽

Standards Of Care ◽

Improvement Plan ◽

Improvement Programs ◽

The Individual

The purpose of this article is to illustrate that setting standards of care is the cornerstone for excellence in diabetes management. This is underpinned by 3 activities: a standards and accreditation process, an audit and benchmarking program and a linked quality improvement plan. While there are many examples of local auditing and quality improvement programs, there are very few that are at a national level. The National Association of Diabetes Centres (NADC) was formed by the Australian Diabetes Society and the Australian Diabetes Educators Association to set standards of diabetes care in Australia. A rigorous accreditation process was put in place to recognize primary, secondary, and tertiary level diabetes centers that meet these standards. The NADC accreditation process is underpinned by a quality improvement plan, which must be submitted for accreditation to be granted and is informed by the Australian National Diabetes Audit (ANDA). ANDA is conducted annually to gather information about treatments, complications, self-care practices and quality of life outcomes and provides a national as well as an individual report to the participating center that is used to benchmark against other like centers. The ANDA reports are important to inform national policy and advocacy for diabetes care and to also provide information for quality improvement purposes for the individual participating center. We believe that the NADC Standards and Accreditation can be an exemplar for other countries to adapt and adopt to standardize diabetes care at the highest level.

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A Review of Pharmacist Contributions to Diabetes Care in the United States

Journal of Pharmacy Practice ◽

10.1177/0897190009336668 ◽

2009 ◽

Vol 23 (3) ◽

pp. 250-264 ◽

Cited By ~ 23

Author(s):

Becky L. Armor ◽

Mark L. Britton ◽

Vincent C. Dennis ◽

Nancy A. Letassy

Keyword(s):

United States ◽

Diabetes Care ◽

Health Care Professionals ◽

Pharmacy Practice ◽

The United States ◽

Standards Of Care ◽

Hemoglobin A ◽

Number Of Patients ◽

Practice Models ◽

Eye Exams

This paper summarizes the outcomes associated with pharmacist involvement in diabetes care in all pharmacy practice settings. Published literature was identified through a search of MEDLINE (1960 to September, week 1, 2008) and International Pharmaceutical Abstracts using the search terms “pharmacist,” “pharmaceutical care,” and “diabetes mellitus.” Only articles reporting clinical or behavior change outcomes were selected for review; papers written outside the United States and citations only in abstract form were not reviewed. The specific data extracted included the following: practice setting, model of care, roles of the pharmacist, study design, number of patients studied, duration of the evaluation, and documented outcomes such as changes in hemoglobin A1c values, adherence to standards of care (lipids, blood pressure, eye exams, foot exams, aspirin use), and changes in quality of life. The greatest improvements in hemoglobin A1c values tend to be observed when pharmacists work in collaborative practice models. Growing evidence demonstrates that pharmacists, working as educators, consultants, or clinicians in partnership with other health care professionals, are able to contribute to improved patient outcomes.

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Conceptual model of collaborative pharmaceutical practice in healthcare and social care for the elderly

Vojnosanitetski pregled ◽

10.2298/vsp161209024i ◽

2018 ◽

Vol 75 (10) ◽

pp. 1020-1029

Author(s):

Velibor Ilic ◽

Valentina Marinkovic ◽

Ljiljana Tasic

Keyword(s):

Conceptual Model ◽

Social Care ◽

Pharmacy Practice ◽

The Elderly ◽

Developed Countries ◽

Collaborative Practice ◽

Bibliographic Databases ◽

Care For The Elderly ◽

Healthcare Practice ◽

Collaborative Pharmacy Practice

Background/Aim. In the new millennium, the focus has been increasingly shifting to optimisation by enhancing the collaborative (common, joint) practice of healthcare professionals, for the purpose of achieving effectiveness and efficiency. Pharmacists are the last link in the healthcare services providing chain. The aim of this study was to present a critical analysis of the published models of the collaborative pharmacy practice along with development of a conceptual model of collaborative pharmacy practice in the healthcare and social care for the elderly population. Methods. Using two search algorithms that were created to search articles published in English, a comprehensive search of the bibliographic databases Web of Science and PubMed was undertaken (up to June 2015). Afterwards, articles were independently assessed by two authors, against predetermined inclusion and exclusion criteria. Results. Regulations on pharmacy collaboration are present in many developed countries. However, the implementation of the collaborative practice is still not widespread. Therefore, a conceptual model of the collaborative healthcare and social care of the elderly provides an insight into a multi-layer structure that has to be established in order to achieve a functioning system of the collaborative healthcare practice. The model concluded that aspirations towards teamwork, communication and above all ? the system of regulators and payers, who acknowledge a healthcare collaboration, are crucial for establishment of a collaborative healthcare practice. Conclusion. This research provides a tool in the form of a guide and check-list for decision-makers and policy-makers in order to achieve the preferred effects generated from the collaborative practice by selecting the models and activities that need to be undertaken for implementation of the collaborative healthcare and social care of the elderly that is best suited for their country.

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Recent advances in treatment of haemodialysis

Journal of the Royal Society of Medicine ◽

10.1177/0141076820972669 ◽

2020 ◽

pp. 014107682097266

Author(s):

James O. Burton ◽

Richard W. Corbett ◽

Philip A. Kalra ◽

Prashanth Vas ◽

Vivian Yiu ◽

...

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Diabetes Management ◽

Mortality Rates ◽

Standards Of Care ◽

Improved Outcomes ◽

Collaborative Paper ◽

Clinical Benefits ◽

Stage Renal Disease ◽

End Stage

Haemodialysis remains the most widely used treatment for patients with end-stage renal disease. Despite the progress that has occurred in the treatment of end-stage renal disease over the last six decades, there has been a failure to translate this into the desired clinical benefits, with morbidity and mortality rates among patients on haemodialysis remaining unacceptably high. Recently, however, there have been expectations that the significant advances that took place over the last few years may result in improved outcomes. New medications for the treatment of anaemia and secondary hyperparathyroidism, as well as novel trends in the areas of iron therapy, diabetes management and physical exercise are among the most important advances which, taken together, are changing the standards of care for patients on haemodialysis. The latest advances, of relevance not only to specialists in Renal Medicine but also to general practitioners caring for these patients, are reviewed in this collaborative paper.

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