Interventions developed to reduce secondary care utilisation in patients with type 2 diabetes mellitus: a narrative review.

OBJECTIVES: To identify, describe and critically appraise the quality of studies of interventions developed to reduce the rate of secondary care utilisation and investigate interventions' impact on patients with type 2 diabetes mellitus (T2DM). METHOD: Using a systematic approach, five databases were searched between 01 January 1995 and 01 February 2021 (MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane database). Inclusion criteria were studies (published in English) in adults with T2DM offered intervention(s) involving medicines/services/educational programmes in any country or setting, with investigated outcomes including the rate of hospital admission/re-admission/accident and emergency visits. Validated tools were used to assess the quality and accuracy of reporting the interventions. A narrative synthesis was used to frame the findings. KEY FINDINGS: A total of 4670 papers were identified, which yielded a final 53 studies after screening against the inclusion criteria. Identified interventions were complex interventions (n = 21) including at least two interventions (e.g. improving medication adherence and patient education), medication management (n = 15), patient education programmes (n = 8), lifestyle interventions (n = 5) and other interventions (n = 4; e.g. dental care). After assessing for quality and effectiveness of interventions, 15 studies remained; 7 were medication management interventions (e.g. use of insulin pen) and 8 were complex interventions (e.g. pharmaceutical care and telehealth systems). Complex interventions showed significant improvement in clinical outcomes and reduction in secondary care utilisation. CONCLUSIONS: This narrative review identified potential elements of an effective complex intervention to reduce healthcare utilisation in patients with T2DM. These results could inform the development of interventions to be tested for feasibility, before piloting to assess for outcomes that improve diabetic care, reduce diabetes-related complications and minimise healthcare utilisation.

Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study.

OBJECTIVES: To investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home. DESIGN AND SETTING: A rapid review and qualitative study exploring PP perceptions of primary care, focusing on CP services in the UK. METHODS: A mixed-methods approach was adopted including a rapid review undertaken between 24 April and 8 May 2019 across four databases (MEDLINE, EMBASE, PsycINFO and CINAHL). Semistructured interviews were then conducted investigating for shifts in current PP perception, but also nuanced opinion pertaining to CP services. A convenience sampling technique was used through two online PP groups for recruitment. Thematic framework analysis was applied to interview transcripts. PARTICIPANTS: Any consenting adults ≥18 years old were invited regardless of their medical condition, and whether they had used post-discharge services or not. RESULTS: Twenty-five studies met the inclusion criteria. Patients were generally supportive and satisfied with primary care services. However, some barriers to the use of these services included: resource limitations; poor communication between healthcare providers or between patient and healthcare providers; and patients' lack of awareness of available services. From the 11 interviewees, there was a lack of awareness of CP post-discharge services. Nevertheless, there was general appreciation of the benefit of CP services to patients, professionals and wider healthcare system. Potential barriers to uptake and use included: accessibility, resource availability, lack of awareness, and privacy and confidentiality issues related to information-sharing. Several participants felt the uptake of such services should be improved. CONCLUSION: There was alignment between the review and qualitative study about high patient acceptance, appreciation and satisfaction with primary care services post-discharge. Barriers to the use of CP post-discharge services identified from interviews resonated with the existing literature; this is despite developments in pharmacy practice in recent times towards clinical and public health services.