A review of pharmacist-led interventions on diabetes outcomes: An observational analysis to explore diabetes care opportunities for pharmacists

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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Strengths-Based Behavioral Intervention for Parents of Adolescents With Type 1 Diabetes Using an mHealth App (Type 1 Doing Well): Protocol for a Pilot Randomized Controlled Trial (Preprint)

10.2196/preprints.9147 ◽

2017 ◽

Author(s):

Marisa E Hilliard ◽

Sahar S Eshtehardi ◽

Charles G Minard ◽

Rana Saber ◽

Debbe Thompson ◽

...

Keyword(s):

Type 1 Diabetes ◽

Behavioral Intervention ◽

Family Relationships ◽

Family Conflict ◽

Diabetes Care ◽

Controlled Trial ◽

Text Messages ◽

Care Providers ◽

Diabetes Outcomes

BACKGROUND Supportive parent involvement for adolescents’ type 1 diabetes (T1D) self-management promotes optimal diabetes outcomes. However, family conflict is common and can interfere with collaborative family teamwork. Few interventions have used explicitly strengths-based approaches to help reinforce desired management behaviors and promote positive family interactions around diabetes care. OBJECTIVE The aim of this protocol was to describe the development of a new, strengths-based behavioral intervention for parents of adolescents with T1D delivered via a mobile-friendly Web app called Type 1 Doing Well. METHODS Ten adolescent-parent dyads and 5 diabetes care providers participated in a series of qualitative interviews to inform the design of the app. The 3- to 4-month pilot intervention will involve 82 parents receiving daily prompts to use the app, in which they will mark the diabetes-related strength behaviors (ie, positive attitudes or behaviors related to living with or managing T1D) their teen engaged in that day. Parents will also receive training on how to observe diabetes strengths and how to offer teen-friendly praise via the app. Each week, the app will generate a summary of the teen’s most frequent strengths from the previous week based on parent reports, and parents will be encouraged to praise their teen either in person or from a library of reinforcing text messages (short message service, SMS). RESULTS The major outcomes of this pilot study will include intervention feasibility and satisfaction data. Clinical and behavioral outcomes will include glycemic control, regimen adherence, family relationships and conflict, diabetes burden, and health-related quality of life. CONCLUSIONS This strengths-based, mobile health (mHealth) intervention aims to help parents increase their awareness of and efforts to support their adolescents’ engagement in positive diabetes-related behaviors. If efficacious, this intervention has the potential to reduce the risk of family conflict, enhance collaborative family teamwork, and ultimately improve diabetes outcomes. CLINICALTRIAL ClinicalTrials.gov NCT02877680; https://clinicaltrials.gov/ct2/show/NCT02877680 (Archived by WebCite at http://www.webcitation.org/6xTAMN5k2)

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Systematic review protocol examining the effects of introducing pay-for-performance for primary care physicians on diabetes outcomes in single-payer healthcare systems (Preprint)

10.2196/preprints.11154 ◽

2018 ◽

Author(s):

Neeru Gupta

Keyword(s):

Systematic Review ◽

Primary Care ◽

Diabetes Care ◽

Primary Care Physicians ◽

Pay For Performance ◽

Unintended Consequences ◽

Research Database ◽

Diabetes Outcomes ◽

Single Payer ◽

Wide Range

BACKGROUND Although pay-for-performance (P4P) for diabetes care is increasingly common across health organizations, evidence of its effectiveness in improving population health and service delivery is deficient. This information gap is attributable in part to the heterogeneity of healthcare financing, covered medical conditions, care settings, and provider remuneration arrangements within and across countries. OBJECTIVE This paper outlines a protocol for a systematic review examining the effects of introducing P4P for physicians in primary care and community settings to support guideline-based diabetes care. Our aim is to reduce the heterogeneity of evidence presented that has deterred conclusiveness of previous reviews by narrowing the focus to disease-specific P4P schemes in single-payer healthcare insurance systems. This approach enables us to minimize the risk of unintended consequences of P4P such as physicians’ gaming the payment system. METHODS Our review systematically searches, appraises, and synthesizes the literature concentrating on whether P4P for primary care physicians leads to better diabetes outcomes in single-payer health systems. We search 10 electronic databases and manually scan the reference lists of review articles and other global health literature. We include primary studies evaluating the effects of introducing P4P for diabetes care among primary care physicians in countries of universal health coverage. Outcomes of interest include patient morbidity, avoidable hospitalization, premature death, and healthcare costs. RESULTS We have received funding from Diabetes Canada and the New Brunswick Health Research Foundation to conduct policy-actionable diabetes health services research. Database searches were conducted and full-texts screened by two reviewers in 2017. We aim to submit the review for publication in 2018. CONCLUSIONS We are narratively synthesizing the data. Because of the wide range of outcomes considered, we do not expect to perform a meta-analysis. Since database searches were completed prior to the publication of this protocol, it is ineligible for registration with PROSPERO.

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Community-Based Participatory Research Interventions to Improve Diabetes Outcomes: A Systematic Review

The Diabetes Educator ◽

10.1177/0145721720962969 ◽

2020 ◽

Vol 46 (6) ◽

pp. 527-539

Author(s):

Jennifer A. Campbell ◽

Alice Yan ◽

Leonard E. Egede

Keyword(s):

Quality Of Life ◽

Blood Pressure ◽

Participatory Research ◽

Diabetes Care ◽

Fasting Glucose ◽

Community Based Participatory Research ◽

Systematic Evaluation ◽

Community Based ◽

Diabetes Outcomes

Purpose The purpose of this study was to conduct a systematic evaluation of community-based participatory research (CBPR) interventions on diabetes outcomes. Understanding of effective CBPR interventions on diabetes outcomes is limited, and findings remain unclear. Methods A reproducible search strategy was used to identify studies testing CBPR interventions to improve diabetes outcomes, including A1C, fasting glucose, blood pressure, lipids, and quality of life. Pubmed, PsychInfo, and CINAHL were searched for articles published between 2010 and 2020. Using a CBPR continuum framework, studies were classified based on outreach, consulting, involving, collaborating, and shared leadership. Results A total of 172 were screened, and a title search was conducted to determine eligibility. A total of 16 articles were included for synthesis. Twelve out of the 16 studies using CBPR approaches for diabetes interventions demonstrated statistically significant differences in 1 or more diabetes outcomes measured at a postintervention time point. Studies across the spectrum of CBPR demonstrated statistically significant improvements in diabetes outcomes. Conclusions Of the 16 studies included for synthesis, 14 demonstrated statistically significant changes in A1C, fasting glucose, blood pressure, lipids, and quality of life. The majority of studies used community health workers (CHWs) to deliver interventions across group and individual settings and demonstrated significant reductions in diabetes outcomes. The evidence summarized in this review shows the pivotal role that CHWs and diabetes care and education specialists play in not only intervention delivery but also in the development of outward-facing diabetes care approaches that are person- and community-centered.

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Diabetes care cascade in Ukraine: an analysis of breakpoints and opportunities for improved diabetes outcomes

BMC Health Services Research ◽

10.1186/s12913-020-05261-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Robyn Margaret Stuart ◽

Olga Khan ◽

Romesh Abeysuriya ◽

Tetyana Kryvchun ◽

Viktor Lysak ◽

...

Keyword(s):

Diabetes Care ◽

Diabetes Outcomes ◽

Care Cascade

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Family-Centered Diabetes Care for Better Glycemic Outcomes of Outpatients in Rural Areas

10.5772/intechopen.96223 ◽

2021 ◽

Author(s):

Mabitsela Hezekiel Mphasha ◽

Tebogo Maria Mothiba

Keyword(s):

Literature Review ◽

Home Care ◽

Diabetes Care ◽

Rural Areas ◽

Family Centered Care ◽

Diabetes Outcomes ◽

Centered Care ◽

Poor Outcomes ◽

Glycemic Outcomes ◽

Family Centered

Most of diabetes care of outpatients takes place at their families. Family members who may have inadequate or lack diabetes knowledge are expected to offer home care, predisposing patients to poor outcomes and associated health problems. To review and discuss literature related to family-centered diabetes care. Comprehensive Literature Review was used to collect data by reviewing literature related to family centered diabetes care. Literature review involved evaluating discoveries of other researchers. The results of literature review showed that family-centered care is essential for better diabetes outcomes and preventing new cases. So far, family-centered care was successful in children’s diabetes care and may be beneficial for older outpatients. Family-centered diabetes care improves knowledge of both patients and families, minimize prevalence and improve diabetes outcomes of outpatients.

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