Pharmacists and GPs provide more cohesive care for diabetes

28 July, 2009

Pharmacists are offering people with poorly controlled type 2 diabetes greater continuity of care and management of their condition through the Diabetes Medication Assistance Service.

The Diabetes Medication Assistance Service is being piloted in approximately 800 pharmacies throughout Australia with each pharmacy supporting up to 14 eligible patients in conjunction with the patient’s General Practitioners (GPs). The service is a 6-month cycle of medication review and support for sufferers of type 2 diabetes and HbA1c.

The latest progress report for the implementation of the Diabetes Medication Assistance Service provided by the University of Sydney has indicated some very positive preliminary findings: evidence is showing on average there has already been a reduction in HbA1c by at least a full percentage point in participants, total cholesterol reduced as well as triglycerides, the proportion of people who smoked has been reduced, and there was a significant improvement noted in adherence to medications.

‘We are pleased with the development of he Diabetes Medication Assistance Service which, along with other programs such as Home Medicines Reviews, sees pharmacists working more closely with GPs to provide more integrated support to people with diabetes.. We know that people with diabetes will benefit from a more integrated approach from a range of health professionals,’ said Greg Johnson Acting CEO of Diabetes Australia.

‘The Diabetes Medication Assistance Service is designed to be a complementary service for patients - it integrates with GP Management Plans and Team Care Arrangements,’ said Kos Sclavos, National President of the Pharmacy Guild of Australia.

Trained community pharmacists in close consultation with the patient’s GP, offer support to patients through: assistance with medication management, blood glucose self-monitoring, diabetes self-management, and other patient goals such as lifestyle changes and co-morbidities such as blood-pressure.

The Diabetes Medication Assistance Service is augmented by other professional pharmacy services such Home Medicines Reviews, Dose Aids Administration (blister packs) and Patient Medication Profiles.

The service is funded by the Australian Government Department of Health and Ageing under the Fourth Community Pharmacy Agreement and managed by the Pharmacy Guild of Australia.

The role of GPs in the Diabetes Medication Assistance Service

The GP confirms a patient’s diagnosis of type 2 diabetes and their HbA1c for that patient to be eligible for the Diabetes Medication Assistance Service. The pharmacist confirms reporting arrangements with the GP, which is particularly important if the GP is utilising the service as part of a GP Management Plan or Chronic Disease Management Team Care Arrangement.

The GP also advises the pharmacist of any other diabetes management initiative, and other clinical measures (such as blood-pressure or lipid levels), to ensure the pharmacist provides the service in line with GP management strategies.

GPs who are aware of the Diabetes Medication Assistance Service report a positive experience. In the most recent progress report, GPs commented on the improved clinical outcomes for their patients. GPs were supportive of the Diabetes Medication Assistance Service being initiated by pharmacists and would refer patients to the program in the future.

Clinical evidence for the Diabetes Medication Assistance Service

The Diabetes Medication Assistance Service is based on research undertaken during the Third Community Pharmacy Agreement which demonstrated improved glycaemic control in patients with type 2 diabetes, as well as improved patient health status and quality of life.

This research tested the service in a national sample of Australian community pharmacies and the results showed that significantly greater improvements in glycaemic control were seen in the group who received the service, compared to those who did not.

For example, a mean reduction in HbA1C of -0.97% (95% CI: -0.8, -1.14) in the intervention group compared with -0.27% (95% CI: -0.15, - 0.39) in the control group. In addition, the mean blood glucose level of the patients who received the service decreased over the six month duration from 9.4mmol/L at the first visit to 8.5mmol/L at the final visit (P <0.01).

Better blood pressure control was also achieved by the intervention group, based on reduction in mean systolic blood pressure readings measured at each visit to the pharmacy. Other benefits included improvements in understanding of long term management of diabetes and adherence to medications. There were also improvements in well-being, quality of life, self-care ability and BMI in the intervention group that were not seen in the control group.