Evaluating pharmacist intervention using the Simpler tool in Malaysian patients with Type 2 diabetes.

Abstract

Introduction: The validated Simpler tool encompasses seven targeted areas for diabetes care and their corresponding indicators to facilitate the delivery of structured, multifaceted interventions and provide consistent, quality type 2 diabetes mellitus (T2DM) care.

Aims: To evaluate the use of the Simpler tool in the management of patients with T2DM to: 1) determine the types and effectiveness of medicine-related and education-related interventions conducted by pharmacists, and 2) evaluate the impact of the interventions on patients’ quality of life (QOL). Methods: Primary healthcare pharmacists (n=14) from the state of Johor, Malaysia, were trained to apply the tool for interventions in patients during a six-month patient follow-up, parallel, two-armed, single-blinded randomised controlled trial. The Simpler tool consists of seven targeted areas for diabetes care (glycaemic and cholesterol control, blood pressure, medicine, lifestyle, cardiovascular risk management and patient education). The WHOQOL-BREF-26 questionnaire was used to assess QOL outcomes.

Results: Data from 55 patients from the intervention arm and 69 from the control arm were analysed. The most common medicine-related problem was non-adherence (44.9%; n=135/301), followed by sub-therapeutic dose (21.6%; n=65/301) and need for additional therapy (17.3%; n=52/301). Pharmacists recommended interventions to prescribers and trained patients in better self-management. Two WHOQOL domains were significantly improved in the intervention group compared with the control group at six months: physical health (14.68 [standard deviation; SD=2.31] versus 13.70 [SD=2.30]; P =0.021); and environment (15.37 [SD=2.16] versus 14.53 [SD=2.05]; P =0.030).

Discussion and conclusions: This study demonstrates the benefits of pharmacists using a structured and consistent multifaceted diabetes tool, the Simpler tool, to make individualised, evidence-based medication and education interventions for patients with T2DM, particularly improvements to physical health and environment QOL domains. The results suggest the need for multifactorial interventions to reduce diabetes-related complications.