Click HERE to access the RxING Practice Tool.
In 2013, the original RxING study, entitled “Pharmacist intervention for glycemic control in the community,” was the first to investigate independent prescribing by pharmacists for diabetes care. Pharmacists systemically identified patients with poor glycemic control, prescribed insulin, and provided intensive education and support to attain adherence. As a result, patients receiving this care achieved significantly improved glycemic control. This is particularly important for two reasons. First, blood sugar control will reduce the potential for other life-altering consequences, including fatal and non-fatal cardiovascular events like stroke and myocardial infarction. Second, pharmacists are highly accessible within the community and are well-positioned to play a bigger role in chronic disease management.
|Lead Investigators||Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC and Yazid N. Al Hamarneh, BSc(Pharm), PhD, CDM|
Optimal community-based care for patients with diabetes remains an enigma
|Study Objective||To evaluate the effect of pharmacist management on uncontrolled risk factors (poor glycemic control, uncontrolled blood pressure or cholesterol, or current smoking) in patients with diabetes.|
|Study Design||Prospective registry, conducted by pharmacists in primary care networks and community pharmacies in Alberta.|
|Screening||Any patient with type 1 or type 2 diabetes who provides written informed consent to have their data collected. Patients must have at least one uncontrolled risk factor to be eligible (poor glycemic control, uncontrolled blood pressure or cholesterol, or current smoking).|
|Recruitment||Pharmacists will recruit patients both through physician referrals as well as using case finding methods such as searching for patients receiving metformin and through viewing laboratory tests such as HbA1c.|
The registry will report both aggregate (anonymous) and by individual provider (for their use only). We will report on standard demographic parameters, including diabetes medication use (use of single and combination products), dosing, antihypertensive and lipid lowering therapies. We will also assess medication adherence.
Clinical outcomes to be assessed will include measures of glycemic control, vaccinations (influenza, pneumococcal and shingles), blood pressure targets, lipid targets, smoking and hypoglycemic symptoms. Humanistic outcomes to be assessed will include quality of life (DQOL, EQ5D) and patient satisfaction (Consultant Satisfaction Questionnaire).
Process outcomes will evaluate pharmacist interventions (medications used, number and nature of pharmacist interventions, follow-ups conducted, adherence counselling). Important subgroups will include those receiving metformin alone, metformin and a second agent, insulin (alone and in combination with oral medications), those patients recruited by physician referral compared to those recruited by case-finding by the pharmacist, Type 1 vs. Type 2 diabetes management.
|Feasibility||Diabetes is of great interest to pharmacists. In a previous survey conducted by our group, diabetes was the top condition of interest in the area of chronic disease management (Rosenthal M, et al, Can Pharm J 2010). Pharmacists will be interested in participating because of the reporting functions of the database. They can print individual patient summaries (to cut/paste into their clinic letters or other documentation requirements, including for billing the provincial health plan) and to generate a report showing their impact on diabetes patients (which helps to justify their positions).|
|What This Study Adds||
At the local level, the generation of provider-specific reports will help pharmacists to show their impact on diabetes patients (important for justification of their position in primary care networks). This registry may also encourage more pharmacists to get involved in diabetes care.
Our future plans include the development of a nationwide diabetes registry for pharmacists, in collaboration with Dr. Lori MacCallum of the Banting and Best Diabetes Centre and other key opinion leaders in pharmacy and diabetes.