Clinical activities that contributed to the effectiveness of a cardiologist–pharmacist collaborative care model in managing diabetes
Abstract Objectives The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in...
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| Published in: | The International journal of pharmacy practice Vol. 31; no. 5; pp. 540 - 547 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
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Oxford University Press
30-09-2023
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| Abstract | Abstract
Objectives
The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in HbA1c.
Methods
This study was a retrospective cohort study conducted in a tertiary hospital over 12 months. Individuals with Type 2 diabetes, aged ≥21 years with established cardiovascular diseases were included while individuals with incomplete care documentation or missing data related to cardiovascular diseases were excluded. Individuals under the care of PCC were matched 1:1 based on baseline HbA1c with an eligible person who received care from the cardiologists (CC). Changes in mean HbA1c were analysed using linear mixed model. Linear regression was used to determine clinical activities that associated with improvement in HbA1c. Moderation analyses were conducted using the MacArthur framework.
Key findings
A total of 420 participants (PCC:210, CC:210) were analysed. The mean age of the participants was 65.6 ± 11.1 years, with the majority being male and Chinese. The mean HbA1c among participants in the PCC group decreased significantly after 6 months (PCC: −0.4% versus CC: −0.1%, P = 0.016), with maintenance of improvement at 12 months (PCC: −0.4% versus CC: −0.2%, P < 0.001). Frequencies of lifestyle counselling, reinforcement of visits to healthcare providers, health education, resolution of drug-related problems, emphasis on medication adherence, dose adjustments and advice on self-care techniques were significantly higher in the intervention group (P < 0.001).
Conclusion
Improvements in HbA1c were associated with the provision of health education and medication adjustments. |
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| AbstractList | The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in HbA1c.
This study was a retrospective cohort study conducted in a tertiary hospital over 12 months. Individuals with Type 2 diabetes, aged ≥21 years with established cardiovascular diseases were included while individuals with incomplete care documentation or missing data related to cardiovascular diseases were excluded. Individuals under the care of PCC were matched 1:1 based on baseline HbA1c with an eligible person who received care from the cardiologists (CC). Changes in mean HbA1c were analysed using linear mixed model. Linear regression was used to determine clinical activities that associated with improvement in HbA1c. Moderation analyses were conducted using the MacArthur framework.
A total of 420 participants (PCC:210, CC:210) were analysed. The mean age of the participants was 65.6 ± 11.1 years, with the majority being male and Chinese. The mean HbA1c among participants in the PCC group decreased significantly after 6 months (PCC: -0.4% versus CC: -0.1%, P = 0.016), with maintenance of improvement at 12 months (PCC: -0.4% versus CC: -0.2%, P < 0.001). Frequencies of lifestyle counselling, reinforcement of visits to healthcare providers, health education, resolution of drug-related problems, emphasis on medication adherence, dose adjustments and advice on self-care techniques were significantly higher in the intervention group (P < 0.001).
Improvements in HbA1c were associated with the provision of health education and medication adjustments. Abstract Objectives The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in HbA1c. Methods This study was a retrospective cohort study conducted in a tertiary hospital over 12 months. Individuals with Type 2 diabetes, aged ≥21 years with established cardiovascular diseases were included while individuals with incomplete care documentation or missing data related to cardiovascular diseases were excluded. Individuals under the care of PCC were matched 1:1 based on baseline HbA1c with an eligible person who received care from the cardiologists (CC). Changes in mean HbA1c were analysed using linear mixed model. Linear regression was used to determine clinical activities that associated with improvement in HbA1c. Moderation analyses were conducted using the MacArthur framework. Key findings A total of 420 participants (PCC:210, CC:210) were analysed. The mean age of the participants was 65.6 ± 11.1 years, with the majority being male and Chinese. The mean HbA1c among participants in the PCC group decreased significantly after 6 months (PCC: −0.4% versus CC: −0.1%, P = 0.016), with maintenance of improvement at 12 months (PCC: −0.4% versus CC: −0.2%, P < 0.001). Frequencies of lifestyle counselling, reinforcement of visits to healthcare providers, health education, resolution of drug-related problems, emphasis on medication adherence, dose adjustments and advice on self-care techniques were significantly higher in the intervention group (P < 0.001). Conclusion Improvements in HbA1c were associated with the provision of health education and medication adjustments. OBJECTIVESThe primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in HbA1c. METHODSThis study was a retrospective cohort study conducted in a tertiary hospital over 12 months. Individuals with Type 2 diabetes, aged ≥21 years with established cardiovascular diseases were included while individuals with incomplete care documentation or missing data related to cardiovascular diseases were excluded. Individuals under the care of PCC were matched 1:1 based on baseline HbA1c with an eligible person who received care from the cardiologists (CC). Changes in mean HbA1c were analysed using linear mixed model. Linear regression was used to determine clinical activities that associated with improvement in HbA1c. Moderation analyses were conducted using the MacArthur framework. KEY FINDINGSA total of 420 participants (PCC:210, CC:210) were analysed. The mean age of the participants was 65.6 ± 11.1 years, with the majority being male and Chinese. The mean HbA1c among participants in the PCC group decreased significantly after 6 months (PCC: -0.4% versus CC: -0.1%, P = 0.016), with maintenance of improvement at 12 months (PCC: -0.4% versus CC: -0.2%, P < 0.001). Frequencies of lifestyle counselling, reinforcement of visits to healthcare providers, health education, resolution of drug-related problems, emphasis on medication adherence, dose adjustments and advice on self-care techniques were significantly higher in the intervention group (P < 0.001). CONCLUSIONImprovements in HbA1c were associated with the provision of health education and medication adjustments. |
| Author | Goh, Cynthia Ee Mei Lum, Zheng Kang Lee, Joyce Yu-Chia Kng, Kwee Keng Gallagher, Paul John Sule, Ashish Anil |
| Author_xml | – sequence: 1 givenname: Zheng Kang orcidid: 0000-0003-0515-9742 surname: Lum fullname: Lum, Zheng Kang – sequence: 2 givenname: Kwee Keng surname: Kng fullname: Kng, Kwee Keng – sequence: 3 givenname: Cynthia Ee Mei surname: Goh fullname: Goh, Cynthia Ee Mei – sequence: 4 givenname: Ashish Anil surname: Sule fullname: Sule, Ashish Anil – sequence: 5 givenname: Paul John surname: Gallagher fullname: Gallagher, Paul John – sequence: 6 givenname: Joyce Yu-Chia orcidid: 0000-0002-3467-9774 surname: Lee fullname: Lee, Joyce Yu-Chia email: j.lee@uci.edu |
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| Cites_doi | 10.1136/bmjopen-2014-005983 10.1001/jamanetworkopen.2020.36725 10.1111/jcpt.12536 10.2471/BLT.08.062364 10.1007/s11892-019-1239-x 10.1001/archneurol.2011.146 10.1007/s13142-017-0494-0 10.1001/archpsyc.59.10.877 10.1016/j.clinthera.2017.10.009 10.1111/ijcp.13288 10.3390/ijerph18136929 10.1177/2047487319878371 10.1155/2018/4930157 10.1016/j.brat.2016.11.001 10.1111/dme.12046 10.1111/ijpp.12572 10.2146/ajhp170789 10.1002/clc.23252 10.1007/s00125-014-3165-4 10.1016/j.diabres.2022.109238 10.1111/jep.12606 10.1136/bmjquality.u201918.w1006 10.1016/j.anr.2016.01.005 10.1161/CIRCRESAHA.120.316101 10.1016/j.pcd.2021.12.013 |
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| Keywords | pharmacist clinic cardiovascular risk collaborative care diabetes clinical activities |
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The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical... The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary... OBJECTIVESThe primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The... |
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