Development of Tailor-made Interventions to improve clinical outcomes of patients with diabetes at Setthathirat hospital, Laos P.D.R

Abstract

Background: Diabetes is a major health problem worldwide. Despite the availability of evidence-based guidance to deliver effective diabetes care, many patients do not achieve treatment and goals in developed countries, is spreading rapidly in developing countries as per recommendations, including in Laos. Pharmaceutical care provided to diabetic patients by pharmacists together with other healthcare providers has shown to be effective in many countries. Diabetes care in Laos has been provided by doctors, nurses, and nutritionists, without the involvement of pharmacists. This study aimed to develop tailor-made interventions for patients with diabetes at Setthathirat hospital, Laos P.D.R.

Methods: This study was undertaken at Diabetes Mellitus clinic, Setthathirat Hospital, Lao PDR. There were 2 major phases including phase 1: the cross-sectional descriptive study and phase 2: the focus group interviews and the feasibility study.

Phase: (I) A cross-sectional descriptive study using questionnaires to measure knowledge and, compliance and to assess drug-related problems (DRPs) and clinical outcomes including HbA1C, FBS, BP.

Phase: (II) Focus Group Interviews: conducting focus group interviews among health care professionals to brainstorming and proposing recommendations for developing tailor-made interventions (TMI). Then, the feasibility study was undertaken to evaluate the health outcomes of developed TMI provided by a pharmacist for uncontrolled diabetic patients.

Result: Phase: (I) The studies consisted of 110 participants with a mean age of 56 year, and 65 of them were women. The average fasting blood sugar was 185mg/dl, hemoglobin A1C (HbA1c) 9.26%, blood pressure 149/84 mm Hg. Compliance with diabetic medication the results with diabetic patients based on the analysis part of the BMQ questionnaire, the patient's compliance was good, but there were issues that needed further monitoring. It was shown that “difficulties to get medicines” was the most common cause (40%) followed by ''forgetting to take this drug on some days or some meals'' (36.4%). The most common DRPs identified by PCNE was “P1.1 no effect of drug treatment despite correct use” (85.5%). The results of the Mann-Whitney U test showed that there was a significant relationship between number of medicines' and drug-related problems (P1.2 Effect of drug treatment not optimal), p-value=0.002.

Phase: (II) Four major themes were identified from the focus group interviews: views of services, role of health care professionals in current practice, views of organizational barriers and views of pharmacists’ roles. All these views were used to help design the process of tailor-made interventions led by pharmacist working with the health care team at Diabetes Clinic. Patient educational tools and monitoring system proposed by the health care team were used for individual patients, including (1) Poster (2) Pamphlets (3) Medication Tracking Schedule (4) Medication Bags (5) phone tracking methods.

Results of the feasibility study investigating health outcomes of providing developed tailor-made interventions for 15 uncontrolled diabetics showed that most of the participants were elderly, with an average age of 59 years and BMI of 24kg/m2. The majority of them had high level of diabetes knowledge. The most common DRPs was P1.1 “No effect of drug treatment despite correct use”, which were mostly caused by non-compliance. Interventions were accepted and fully implemented by the physician, however, it was accepted and partially implemented by the patients. The average of FBS and both systolic and diastolic blood pressure were significantly decreased after patients received TMI by the pharmacist (p-value< 0.001).

Conclusion: A tailor-made interventions for individual diabetic patients were crucial and could be implemented in the process of care and services based in the hospital. It should also be incorporated into the quality improvement program for patient communications as it showed significant and relevant impacts on patients’ communications, self-reflection, self-awareness and individual health outcomes. It is also important to consider the demographic and psychosocial characteristics of patients with diabetes and their expertise and experiences of diabetes.

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