Services Database Diabetes MUR+ & Diabetes Risk Assessment

The award winning Devon LPC pharmacist led diabetes support service was completed in twelve healthy living pharmacies (HLP) in Plymouth over an 8 week period as part of the Devon LPC HLP evaluation. Pharmacists received mandatory training on improving compliance in patients with diabetes and a comprehensive knowledge update for the disease area. The aim of the service was to improve adherence to medicines by pharmacists providing educational interventions and behavioural support.

111 patients took part in the pharmacist led diabetes consultation interventions in 12 HLPs. 43% of patients had medium or low adherence to their diabetes medicines measured by the Morisky-8 score. The pharmacist provided a number of recommendations to help the patient better manage their condition, at the stage one consultation, 72.1% of patients agreed to follow all the pharmacist's recommendations. The stage two consultations indicated that 55.9% were adhering to all recommendations with one in three patients adhering to “some recommendations”. An independent researcher conducted a follow up with a number of patients (34), (6) patients who had reported a low adherence score (3) improved their adherence by a mean of 45% from an adherence score of 3.2 to 5.8. If this is indicative for all the twenty three patients recorded with low this would have decreased the low adherers by 50%. Patients indicated a high regard for the service using a validated questionnaire and scored service levels very highly; ‘I appreciated the service’ (4.97, scale 1 strongly disagree 5 strongly agree), ‘I am satisfied with the pharmacist' (4.97).

This pilot has demonstrated that patients had a high regard for the pharmacist led diabetes patient support service and scored service levels very highly. Patients also self-reported good compliance with the pharmacist’s recommendations with regard to lifestyle interventions. Patients with poor adherence when entering the diabetes support service significantly improved their adherence (mean improvement 45%) following the pharmacist interventions, with three patients (50%) moving from ‘low adherer’ to ‘medium adherer’ group in the post evaluation cohort. The authors suggested the results warrant a more comprehensive study including a control arm comparing a non-interventional approach is undertaken to assess the positive impact of pharmacists on the control of diabetes.

This is not a commissioned service.

 

Diabetes MUR Plus Service - Pharmacists had to attend a training course to increase their understanding of diabetes and best practice management. The course aimed to help the pharmacist influence the patient's beliefs to improve compliance to medicine regimes in order to effectively support the patient in achieving positive outcomes. Additional training included:

1. completion of the e-learning course 'Medicine adherence in diabetes' produced by South London, Health Innovation and Education Cluster;
2. to have read and have knowledge of the Devon LPC diabetes MUR tool kit, and understand how to use the consultation brief and patient management record;
3. to have good knowledge of the NICE guidance for treatment of type II and type I treatment and management, and knowledge of local formulary choices for medicines; and 
4. attendance at a pharmacist clinical cases training evening presented by Mr M Stone (Pharmacist prescriber) and Mr P English (consultant endocrinologist). This covered current treatment guidance and worked through a number of clinical cases to support the pharmacist in delivering the MUR Plus.

Diabetes Risk Assessment - Attendance at a training event - three members of staff from each pharmacy could attend.