The Impact of Pharmacist Care on Diabetes Outcomes in Primary Care Settings: An Umbrella Review of Systematic Reviews

Objective: To systematically review published systematic reviews (SRs) examining the impact of pharmacist interventions in multidisciplinary diabetes care teams on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Methods: PubMed, EMBASE, Scopus, Database of Abstracts of Reviews of Effects, Cochrane Library, Joanna Briggs Institute (JBI) Database, Google Scholar, and PROSPERO were searched from inception to 2018. Studies published in English evaluating the effect of pharmacist interventions on diabetes outcomes were included. Two independent reviewers were involved in the screening of titles and abstracts, selection of studies, and methodological quality assessment. Results: Seven SRs were included in the study. Three of them included only randomized controlled trials, while the rest involved other study designs. Educational interventions by clinical pharmacists within the healthcare team were the most common types of interventions reported across all SRs. Pharmacist’s interventions compared to usual care resulted in favorable significant improvements in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, body mass index, total cholesterol, lowdensity lipoprotein, high-density lipoprotein and triglycerides in more than 50% of the SRs. Improvement in HbA1c was the mostly reported clinical outcome of pharmacist intervention in the literature (reported in six SRs). Pharmacist’s interventions led to significant cost-saving ($8–$85,000 per person per year), cost-utility, and cost-benefit (benefit-to-cost ratio range from 1:1 to 8.5:1) versus usual care. Pharmacist’s interventions improved patients’ quality of life (QoL) in three SRs; however, no conclusion can be drawn due to the use of diverse QoL assessment tools. Conclusion: Most SRs support the benefit of pharmacist care on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Improvements in diabetes outcomes can significantly reduce the burden of diabetes on the healthcare system. Hence, the incorporation of pharmacists into multidisciplinary diabetes care teams is beneficial and should be strongly considered by clinicians and health policymakers.

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The impact of pharmacist care on diabetes outcomes in primary care settings: An umbrella review of published systematic reviews

Primary Care Diabetes ◽

10.1016/j.pcd.2019.12.007 ◽

2020 ◽

Vol 14 (5) ◽

pp. 393-400 ◽

Cited By ~ 2

Author(s):

Sara Abdulrhim ◽

Sowndramalingam Sankaralingam ◽

Mohamed Izham Mohamed Ibrahim ◽

Ahmed Awaisu

Keyword(s):

Primary Care ◽

Systematic Reviews ◽

Umbrella Review ◽

Diabetes Outcomes ◽

Primary Care Settings ◽

The Impact ◽

Pharmacist Care

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Impact of Interprofessional Primary Care Practice on Patient Outcomes: A Scoping Review

SAGE Open ◽

10.1177/2158244020935899 ◽

2020 ◽

Vol 10 (2) ◽

pp. 215824402093589

Author(s):

Livia R. M. McCutcheon ◽

Stuart T. Haines ◽

Ruta Valaitis ◽

Deborah A. Sturpe ◽

Grant Russell ◽

...

Keyword(s):

Primary Care ◽

Patient Outcomes ◽

Primary Care Practice ◽

Collaborative Practice ◽

Economic Outcomes ◽

Future Research ◽

Care Practice ◽

Interprofessional Collaborative Practice ◽

Primary Care Settings ◽

The Impact

Systematic reviews have provided some insight into the impact of interprofessional collaborative practice on patient outcomes. Despite strong interest in interprofessional collaborative practice, relatively little is known about its impact in primary care settings. This scoping literature review describes the essential elements of an interprofessional primary care practice and explores what is known about its impact on patient care including clinical, humanistic, and economic outcomes. We completed a review of the literature examining the breadth of knowledge related to interprofessional collaborative practice in primary care settings. A search was conducted to identify studies based on predefined criteria. A total of 51 studies met the criteria. A total of 27 studies reported a significantly positive clinical outcome with the interprofessional collaborative practice model, 27 studies reported no difference, and one study reported negative outcome in mortality. A total of 15 studies reported a significantly positive humanistic outcome. There was little to no difference in economic outcomes. This study provides new insights for future research that examines the impact of interprofessional primary care practice.

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Clinical impact of pharmacist-led antibiotic stewardship programs in outpatient settings in the United States: A scoping review

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab178 ◽

2021 ◽

Author(s):

James St. Louis ◽

Arinze Nkemdirim Okere

Keyword(s):

United States ◽

Usual Care ◽

Antibiotic Stewardship ◽

The United States ◽

Controlled Trials ◽

Antibiotic Prescribing ◽

Successful Implementation ◽

Pharmacist Interventions ◽

Outpatient Settings ◽

The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To provide an overview of the impact of pharmacist interventions on antibiotic prescribing and the resultant clinical outcomes in an outpatient antibiotic stewardship program (ASP) in the United States. Methods Reports on studies of pharmacist-led ASP interventions implemented in US outpatient settings published from January 2000 to November 2020 and indexed in PubMed or Google Scholar were included. Additionally, studies documented at the ClinicalTrials.gov website were evaluated. Study selection was based on predetermined inclusion criteria; only randomized controlled trials, observational studies, nonrandomized controlled trials, and case-control studies conducted in outpatient settings in the United States were included. The primary outcome was the observed differences in antibiotic prescribing or clinical benefits between pharmacist-led ASP interventions and usual care. Results Of the 196 studies retrieved for full-text review, a cumulative total of 15 studies were included for final evaluation. Upon analysis, we observed that there was no consistent methodology in the implementation of ASPs and, in most cases, the outcome of interest varied. Nonetheless, there was a trend toward improvement in antibiotic prescribing with pharmacist interventions in ASPs compared with that under usual care (P < 0.05). However, the results of these studies are not easily generalizable. Conclusion Our findings suggest a need for a consistent approach for the practical application of outpatient pharmacist-led ASPs. Managed care organizations could play a significant role in ensuring the successful implementation of pharmacist-led ASPs in outpatient settings.

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Implications of remote monitoring Technology in Optimizing Traditional Self-Monitoring of blood glucose in adults with T2DM in primary care

BMC Endocrine Disorders ◽

10.1186/s12902-021-00884-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alex R. Montero ◽

David Toro-Tobon ◽

Kelly Gann ◽

Carine M. Nassar ◽

Gretchen A. Youssef ◽

...

Keyword(s):

Primary Care ◽

Blood Glucose ◽

Diabetes Care ◽

Remote Monitoring ◽

Secondary Analysis ◽

Time Of Day ◽

Trial Registration ◽

Blood Glucose Monitoring ◽

Self Monitoring ◽

The Impact

Abstract Background Self-monitoring of blood glucose (SMBG) has been shown to reduce hemoglobin A1C (HbA1C). Accordingly, guidelines recommend SMBG up to 4–10 times daily for adults with type 2 diabetes (T2DM) on insulin. For persons not on insulin, recommendations are equivocal. Newer technology-enabled blood glucose monitoring (BGM) devices can facilitate remote monitoring of glycemic data. New evidence generated by remote BGM may help to guide best practices for frequency and timing of finger-stick blood glucose (FSBG) monitoring in uncontrolled T2DM patients managed in primary care settings. This study aims to evaluate the impact of SMBG utility and frequency on glycemic outcomes using a novel BGM system which auto-transfers near real-time FSBG data to a cloud-based dashboard using cellular networks. Methods Secondary analysis of the intervention arm of a comparative non-randomized trial with propensity-matched chart controls. Adults with T2DM and HbA1C > 9% receiving care in five primary care practices in a healthcare system participated in a 3-month diabetes boot camp (DBC) using telemedicine and a novel BGM to support comprehensive diabetes care management. The primary independent variable was frequency of FSBG. Secondary outcomes included frequency of FSBG by insulin status, distribution of FSBG checks by time of day, and hypoglycemia rates. Results 48,111 FSBGs were transmitted by 359 DBC completers. Participants performed 1.5 FSBG checks/day; with 1.6 checks/day for those on basal/bolus insulin. Higher FSBG frequency was associated with greater improvement in HbA1C independent of insulin treatment status (p = 0.0003). FSBG frequency was higher in patients treated with insulin (p = 0.003). FSBG checks were most common pre-breakfast and post-dinner. Hypoglycemia was rare (1.2% < 70 mg/dL). Conclusions Adults with uncontrolled T2DM achieved significant HbA1C improvement performing just 1.5 FSBGs daily during a technology-enabled diabetes care intervention. Among the 40% taking insulin, this improvement was achieved with a lower FSBG frequency than guidelines recommend. For those not on insulin, despite a lower frequency of FSBG, they achieved a greater reduction in A1C compared to patients on insulin. Low frequency FSBG monitoring pre-breakfast and post-dinner can potentially support optimization of glycemic control regardless of insulin status in the primary care setting. Trial registration Trial registration number:NCT02925312 (10/19/2016).

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The Effects of Heatwaves on Human Morbidity in Primary Care Settings: A Case-Crossover Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020832 ◽

2022 ◽

Vol 19 (2) ◽

pp. 832

Author(s):

Mahmoud Alsaiqali ◽

Katrien De Troeyer ◽

Lidia Casas ◽

Rafiq Hamdi ◽

Christel Faes ◽

...

Keyword(s):

Primary Care ◽

Crossover Study ◽

Respiratory Infection ◽

Respiratory Infections ◽

Infection Risk ◽

Incidence Density ◽

Acute Effects ◽

Primary Care Settings ◽

Case Crossover ◽

The Impact

Purpose: This study assesses the potential acute effects of heatwaves on human morbidities in primary care settings. Methods: We performed a time-stratified case-crossover study to assess the acute effects of heatwaves on selected morbidities in primary care settings in Flanders, Belgium, between 2000 and 2015. We used conditional logistic regression models. We assessed the effect of heatwaves on the day of the event (lag 0) and X days earlier (lags 1 to X). The associations are presented as Incidence Density Ratios (IDR). Results: We included 22,344 events. Heatwaves are associated with increased heat-related morbidities such as heat stroke IDR 3.93 [2.94–5.26] at lag 0, dehydration IDR 3.93 [2.94–5.26] at lag 1, and orthostatic hypotension IDR 2.06 [1.37–3.10] at lag 1. For cardiovascular morbidities studied, there was only an increased risk of stroke at lag 3 IDR 1.45 [1.04–2.03]. There is no significant association with myocardial ischemia/infarction or arrhythmia. Heatwaves are associated with decreased respiratory infection risk. The IDR for upper respiratory infections is 0.82 [0.78–0.87] lag 1 and lower respiratory infections (LRI) is 0.82 [0.74–0.91] at lag 1. There was no significant effect modification by age or premorbid chronic disease (diabetes, hypertesnsion). Conclusion: Heatwaves are associated with increased heat-related morbidities and decreased respiratory infection risk. The study of heatwaves’ effects in primary care settings helps evaluate the impact of heatwaves on the general population. Primary care settings might be not suitable to study acute life-threatening morbidities.

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Screening in Diabetes Care: Detecting and Managing Depression in Diabetes

Screening for Depression in Clinical Practice ◽

10.1093/oso/9780195380194.003.0019 ◽

2009 ◽

Author(s):

Norbert Hermanns ◽

Bernhard Kulzer

Keyword(s):

Primary Care ◽

Diabetes Care ◽

Meta Analysis ◽

Treatment Options ◽

Recognition Rate ◽

Depression Screening ◽

Screening Tests ◽

Diabetic Patients ◽

Primary Care Settings ◽

Care Approach

The analysis of depression screening in diabetes according to the four criteria of the United Kingdom’s National Screening Committee shows that both screening tests and treatment options are available. However, results of the Cochrane meta-analysis about depression screening in primary care settings indicate that the implementation of depression screening needs a structured approach to link these two components. A stepped-care approach comprising verification of positive screening results, treatment options, assessment of response to treatment, and adaptation may carry favorable results with regard to reduction of depression as well as cost-effectiveness. The association between diabetes and distress has long been recognized. In 1685 Thomas Willis, a British physician, suggested that diabetes might be a consequence of prolonged sorrow. In the middle of the 20th century Alexander regarded diabetes as one of the seven major psychosomatic diseases. In more recent years these historical observations have been supported by growing empirical evidence of a special relationship between emotional distress and diabetes. A meta-analysis regarding depression and diabetes onset showed that the presence of depressed symptoms increased the risk of developing diabetes by 37%. However, the effect is bidirectional. Meta-analytic findings suggest that the comorbidity of depression and diabetes is frequent: approximately one third of diabetic patients report symptoms of depression, and a smaller group of10%of diabetic patients meet the criteria of a clinical depression. In diabetes care settings the recognition rate of depression in diabetic patients is disappointingly low, ranging between20%and50%. Even in more specialized diabetes care settings approximately 50% of depressed diabetic patients remain undetected. Thus, there are strong and compelling arguments in favor of depression screening in diabetes, and this is also recommended by several guidelines for diabetes care (Fig. 16.1). However, there are also arguments against depression screening. Studies analyzing the effectiveness of depression screening in primary care settings do not all support large-scale implementation of depression screening. Increasingly, there is a need to justify depression screening in different medical conditions with regard to its effectiveness and ethical and clinical implications and to specify whether screening as a routine or more selective case-finding is warranted.12 Screening for depression potentially exposes both false positives and true positives (but otherwise unrecognized cases) to stigmatization and potential discrimination by health insurance companies or employers.

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The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study

Pharmacy ◽

10.3390/pharmacy8030113 ◽

2020 ◽

Vol 8 (3) ◽

pp. 113

Author(s):

Mo Chen ◽

Tejal Patel ◽

Feng Chang

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Chronic Pain ◽

Cancer Pain ◽

Family Health ◽

Primary Care Settings ◽

Pain Intervention ◽

Family Health Team ◽

The Impact

Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist-driven chronic pain intervention on pain and quality of life in patients with chronic non-cancer pain. A three-month naturalistic prospective study was conducted in primary care settings (five community pharmacies and one Family Health Team) across Ontario, Canada with a total of six pharmacists and 19 study participants. The primary care, pharmacist-driven chronic pain intervention consisted of patient assessments, medication reviews, care plan recommendations, and patient education. In order to evaluate the effectiveness of the intervention, pain intensity, pain interference, and quality of life were evaluated at baseline and at follow up (week 2 and month 3). Results: Trends towards improvement in pain and quality of life were found, however, these improvements were not statistically significant at follow up (month 3). Conclusions: This study provides the foundational research required to better understand the impact of Ontario pharmacists’ extended role in pain management in non-cancer patients within multiple primary care settings (e.g., Family Health Team, etc.) and has illustrated the importance of modifying and customizing care plans in patients with chronic pain. A larger sample size with tailored outcome measures may be necessary to better highlight significant improvements in pain and quality of life in patients with chronic non-cancer pain using a primary care, pharmacist-driven intervention.

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Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

Mental Illness ◽

10.4081/mi.2010.e10 ◽

2010 ◽

Vol 2 (1) ◽

pp. 46-50 ◽

Cited By ~ 9

Author(s):

Olawale O. Ogunsemi ◽

Francis A. Oluwole ◽

Festus Abasiubong ◽

Adebayo R. Erinfolami ◽

Olufemi E. Amoran ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Mental Disorders ◽

Patient Health Questionnaire ◽

Health Questionnaire ◽

Primary Care Settings ◽

Primary Health ◽

Patient Health ◽

The Impact

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

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