Pharmacist-led transition of care in diabetic patients

Abstract

Pharmacist-led interventions have shown to decrease drug-related problems (DRPs) and improve clinical outcomes. This study aimed to develop and implement a pharmaceutical service at the outpatient setting for diabetic patients focusing on medicine reconciliation and effective Transition of Care. This prospective investigational study was conducted at Mater Dei Hospital diabetic clinic in the outpatient department where patients >18 years of age, taking at least one antidiabetic medication were eligible to participate in the study. A Transition of Care document, aimed at compiling the necessary medical information obtained during the medicine reconciliation undertaken during this study, was developed and disseminated to the patients’ community pharmacist via electronic mail. Three questionnaires were developed, one was sent together with the Transition of Care document to the community pharmacist to assess the effectiveness of the document, a second questionnaire was completed by the patient to assess the pharmacist intervention, and the third questionnaire was disseminated to the diabetologists, diabetic specialists and the diabetic nurses working at the diabetic outpatient clinic. Hundred patients were recruited in the study. One hundred ninety-four drug-related problems were identified during the medicine reconciliation and classified into six categories. The four most prevalent DRPs were “Lack or misinterpretation of information” (n=48), “Insufficient awareness of health and diseases” (n=47), “Inappropriate timing of administration and/or dosing interval” (n=36) and “Nonadherence to treatment” (n=27). Eighty-five patients required verbal intervention from the clinical pharmacist, nine patients required written advice and four patients required both written and verbal intervention. The Transition of Care document was disseminated to 73 community pharmacists. Forty-one community pharmacists completed the questionnaire and unanimously agreed that there is a need for better communication between hospital pharmacist and the community. Patients (98%) reacted positively to the clinical service offered by the pharmacist at the diabetic clinic while all healthcare professionals (N=9) encouraged the addition of a clinical pharmacist to the diabetic team. The implementation of the developed pharmacist-led Transition of Care service was shown to be relevant to the outpatient diabetic group, as demonstrated by the identified DRPs. The effectiveness of the Transition of Care document needs to be further evaluated.