Evaluation of community pharmacist follow-up supported by the use of healthcare technology for type 2 diabetes patients.

Background: Prevalence of type 2 diabetes is high in Belgium (estimated at over 10%, 1 patient out of 3 being unaware of their diagnosis). Management based on a change of lifestyle and the adoption of health-promoting behaviors, supplemented when needed with drug treatment, prevents complications, improves the patient's quality of life and reduces mortality. Multidisciplinary patient support is essential. In this, pharmacists have a key role, e.g. through therapeutic patient education activities, in which they are increasingly involved. Moreover, research suggests that the use of mobile technologies can be a useful tool for helping patients with their daily life and disease management. Objectives: This study aims at exploring the benefits of community pharmacist follow-up supported by the use of mobile technologies in the monitoring of individuals with type 2 diabetes. The presented intervention aimed to reinforce the patients' willingness to actively participate in the management of their disease and to adopt favorable health behaviors, in order to increase their level of medication adherence. Methods: A quantitative quasi-experimental study was conducted in community pharmacies throughout Belgium over a 6-month period with 3 data collection periods (before, during and after the intervention). Primary outcomes, related to the level of medication adherence, and secondary outcomes, considered as markers of the patient's overall health, were analyzed. In addition, qualitative data concerning participants' opinions on their experience were collected. Results: 66 patients participated in the study, with 50 remaining after 3 months and 46 completing the entire study. Statistical analyses did not show an improvement in the level of medication adherence. This parameter was high from the beginning, reflecting patients with controlled diabetes. However, statistically significant results were observed for systolic blood pressure and waist circumference (both improved), while other outcomes showed a positive trend or remained stable. Patient follow-up by the pharmacist was a positive experience for both parties which noted their interest and satisfaction for the project. Conclusions: Although clinical results are not conclusive, patients were motivated and the attrition rate was low. Participants showed their interest in participating in this kind of project, opening up opportunities for further studies in the community pharmacy setting. As front-line health professionals, community pharmacists certainly have a key-role to play in therapeutic patient education and mobile technologies could be additional tools in this process.

A pharmacist-conducted medication review in nursing home residents: impact on the appropriateness of prescribing.

Medication use in nursing homes is often suboptimal. This study investigated the impact of a pharmacist-conducted medication review on the appropriateness of prescribing for Belgian nursing home residents. We conducted a 6-month controlled, non-randomized study in two nursing homes (one intervention and one control nursing home). Sixty-nine residents completed the study in the intervention group (92 residents were included). For the control group, that were 79 residents (100 residents were included). Primary outcome was the appropriateness of prescribing, assessed by a set of validated quality indicators. At baseline, this study detected three main problems associated with the appropriateness of medication use: (i) the Medication Appropriateness Index (MAI) could be improved (continuation of no longer indicated medication was the most common problem), (ii) potential overuse was present in about half of the group, and (iii) potential underuse was present in about 30% of the sample. Despite this, our pharmacist-conducted medication review only modestly improved the appropriateness of prescribing. This may be attributed to the low implementation rate of the pharmacist recommendations.

[Self-medication of upper gastrointestinal symptoms: a community pharmacy study]. / Automédication des troubles gastriques: étude dans les pharmacies belges.

BACKGROUND: Upper gastrointestinal (GI) symptoms are a common reason for self-treatment with over-the-counter (OTC) medication. However, data on the typology of GI complaints for which individuals seek self-medication and, more importantly, on the prevalence of alarm symptoms in this population are scarce. OBJECTIVE: This study aimed to investigate: (i) the nature of GI symptoms people intend to self-medicate, (ii) prevalence of alarm symptoms, (iii) compliance with referral advice given by the pharmacist, and (iv) self-reported efficacy and frequency of use of OTC medication for minor complaints. METHODS: This descriptive study was performed in 63 community pharmacies. Participants (n=592, aged 18-80 y) completed a questionnaire to assess symptom characteristics and previous medical consulting. Based on this information, the pharmacist referred subjects to a physician or advised self-treatment. Four weeks later, participants were presented a follow-up questionnaire, evaluating compliance with referral advice or efficacy of self-treatment. RESULTS: The most frequently reported GI complaints were burning retrosternal discomfort (49.2%), acid regurgitation (53.2%) and bothersome postprandial fullness (51.2%). At least 1 alarm symptom was present in 22.4% of the individuals, difficulty in swallowing being the most prevalent one (15.4%). Although twenty-one percent of the customers were referred, only 51.7% of these actually contacted a physician. Almost all of the remaining customers who were advised self-treatment reported symptom relief with the obtained OTC drug (95.1%). CONCLUSIONS: Mild GI symptoms will mostly resolve with self-treatment. Yet, the value of pharmacist counselling on OTC treatment should be recognized, as community pharmacists can play an important role in