Clinical results of a comprehensive medication management program in a diabetes ambulatory clinic

Abstract

Introduction: Pharmacotherapy used for Diabetes mellitus (DM) often results in failure or difficulty in achieving therapeutic goals. To assist these patients, the Management Drug Therapy (MDT) aims at the identification, resolution, and prevention of Drug Related Problems (DRP). Objectives: To evaluate the clinical results of an MDT program and associated factor with the detection of drug therapy problems (DTP). Methods: A longitudinal quasi-experimental study was performed including all patients followed up in the MTD program (n=38) during three years. The associated factors with the detection of three DTP or over in the initial evaluation assessment were evaluated by univariate (Pearson’s chi- square test) and multivariate analysis (logistic regression). The clinical impact of the service was assessed by comparing initial and final clinical and laboratory parameters (HbA1c, Arterial Pressure, and LDLc) with covariance a covariance analysis. Results: 108 DTPs were identified. Their main causes were dose too low (n=47; 43%) and non-adherence (n=22; 20%). Considering the patients that had at least two MTD consultations (33 patients with 105 DTPs), 60% of the DTP were resolved. To solve them, 52 interventions were made with prescribers (45 were accepted), and 54 interventions made directly with patients. The use of 10 or more drugs was positively associated with the identifications of 3 DTP or over in the initial assessment (OR 6.3; 95%CI 1.3-30.6). A statistically significant reduction was detected in the patients’ LDLc at the end of the follow-up period. Conclusions: The clinical service helped to resolve DTP and improved clinical results.