An evaluation of pharmaceutical care delivery to patients with diabetes and development of standardised assessment tools

Abstract

Background Diabetes is a rapidly and serious health problem in Scotland. This chronic condition is associated with serious long-term complications, including higher risk of heart disease and stroke. Aggressive treatment of hypertension and hyperlipideamia can result in a substantial reduction in cardiovascular events in patients with diabetes 1. Consequently pharmacist-led diabetes cardiovascular risk (DCVR) clinics have been established in both primary and secondary care sights in NHS Lothian during the past five years. An audit of the pharmaceutical care delivery at the clinics was conducted in order to evaluate practice and to standardise the pharmacists’ documentation of outcomes. Methods Pharmaceutical care issues (PCI) and patient details were collected both prospectively and retrospectively from three DCVR clinics. The PCI`s were categorised according to a triangularised system consisting of multiple categories. These were ‘checks’, ‘changes’ (‘change in drug therapy process’ and ‘change in drug therapy’), ‘drug therapy problems’ and ‘quality assurance descriptors’ (‘timer perspective’ and ‘degree of change’). A verified medication assessment tool (MAT) for patients with chronic cardiovascular disease was applied to the patients from one of the clinics. The tool was used to quantify PCI`s and pharmacist actions that were centred on implementing or enforcing clinical guideline standards. A database was developed to be used as an assessment tool and to standardise the documentation of achievement of outcomes. Feedback on the audit of the pharmaceutical care delivery and the database was received from the DCVR clinic pharmacist at a focus group meeting. Results For the 47 study patients ( 44.7 % male, 85.1 % type 2 diabetes mellitus) mean (SD) age was 65.7 (12.6) years and mean (SD) time since diagnosis of diabetes was 14.9 (8.9) years. Overall number of identified care issues was 727 with mean (SD) 3.9 (1.3) care issues per care episode. Of the total care issues, 373 (51.3 %) were ‘checks’, 211 (29.0%) were ‘changes in drug therapy process’ and 147 (19.7 %) were ‘changes in drug therapy’ and an identified ‘drug therapy problem’ (DTP). Of the checks, 519 (88.9 %) were ‘monitoring’ checks, while all changes, 143 (100 %), were ‘adjustments’. The number of patients included in the application of the MAT guideline standards was 33. A total of 51 care issues leading to a change in the medication was identified and resulted in 130 guideline standards that were directing the goal of the medication change. Conclusion The results from the audit showed that the pharmacist made a major contribution to ensure effective and safe treatment for the patients and optimising drug doses. Lack of pharmacist documentation was the reason for discrepancy from practice in some areas of the pharmaceutical care delivery. A database would help to standardise the documentation of pharmacist actions and identification of pharmaceutical care issues. Further refinement of the tool will likely improve the ease of use and minimise the time required for application.