La Regina Raffaele, Pandolfi Dario, Stabile Nicola, Beloni Lucio, Glisenti Fulvio, Griggio Paola, La Regina Micaela, La Regina Giuseppe
Community Pharmacy, Farmacia La Regina, 84030 San Rufo (SA), Italy.
Community Pharmacy, Farmacia Pandolfi, 84016 Pagani (SA), Italy.
Pharmacy (Basel). 2020 Oct 19;8(4):193. doi: 10.3390/pharmacy8040193.
The adherence of type 2 diabetes mellitus (DM2) patients with an individual care plan (ICP) is often not satisfactory, nor does it allow for a significant improvement in outcome, because of poor accessibility to services, poor integration of pathway articulations, poor reconciliation with the patient's life, or the lack of a constant reference person. The purpose of this study was to evaluate the contribution of community pharmacists and pharmacy services in improving adherence with periodic controls in DM2. The study was conducted at a rural pharmacy. A sample of 40 patients was calculated with respect to a historical cohort and subsequently enrolled. Clinical and personal data were collected in an electronic case report form. Pharmacists acting as a case manager followed patients carrying out their ICP developed by an attending physician. Some of the activities foreseen by the ICP, such as electrocardiogram, fundus examination, and self-analysis of blood and urine, were carried out directly in the pharmacy by the pharmacist through the use of telemedicine services and point of care units. Activities that could not be performed in the pharmacy were booked by the pharmacist at the accredited units. Examination results were electronically reported by the pharmacist to the attending physician. The primary endpoint was the variation in patient adherence with the ICP compared to a historical cohort. Secondary endpoints were variation in waiting time for the examinations, mean percentage change in glycated hemoglobin (HbA1c) and low-density lipoprotein (LDL) cholesterol levels and blood pressure, impact on healthcare-related costs, and perceived quality of care. Adherence to the ICP significantly increased. Waiting times were reduced and clinical outcomes improved with conceivable effects on costs. Patients appreciated the easier access to services. Community pharmacists and pharmacy services represent ideal actors and context that, integrated in the care network, can really favor ICP adherence and obtain daily morbidity reduction and cost savings through proper disease control and an early diagnosis of complications.
2型糖尿病（DM2）患者对个体化护理计划（ICP）的依从性通常不尽人意，也无法显著改善治疗效果，原因在于服务可及性差、路径衔接整合不佳、与患者生活难以协调，或者缺乏固定的联络人。本研究的目的是评估社区药师及药房服务在提高DM2患者定期检查依从性方面的作用。该研究在一家乡村药房开展。根据一个历史队列计算出40名患者的样本量，随后进行入组。临床和个人数据通过电子病例报告表收集。担任病例管理者的药师跟踪由主治医师制定的ICP的患者。ICP预设的一些活动，如心电图、眼底检查以及血液和尿液自我分析，由药师在药房通过远程医疗服务和即时检验设备直接进行。无法在药房进行的活动由药师在认可的单位预约。药师将检查结果以电子方式报告给主治医师。主要终点是与历史队列相比患者对ICP依从性的变化。次要终点包括检查等待时间的变化、糖化血红蛋白（HbA1c）和低密度脂蛋白（LDL）胆固醇水平及血压的平均百分比变化、对医疗相关成本的影响以及感知的护理质量。对ICP的依从性显著提高。等待时间缩短，临床结果改善，对成本也有可预见的影响。患者对更便捷的服务表示满意。社区药师及药房服务是理想的参与者和环境，融入护理网络后，确实能够促进对ICP的依从性，并通过适当的疾病控制和并发症的早期诊断实现每日发病率降低和成本节约。
