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  Title Community-based care for the management of type 2 diabetes: an evidence-based analysis Type Journal Article
  Year 2009 Publication Ontario Health Technology Assessment Series Abbreviated Journal Ont Health Technol Assess Ser  
  Volume 9 Issue 23 Pages 1-40  
  Keywords  
  Abstract In June 2008, the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project, an evidence-based review of the literature surrounding strategies for successful management and treatment of diabetes. This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry's newly released Diabetes Strategy.After an initial review of the strategy and consultation with experts, the secretariat identified five key areas in which evidence was needed. Evidence-based analyses have been prepared for each of these five areas: insulin pumps, behavioural interventions, bariatric surgery, home telemonitoring, and community based care. For each area, an economic analysis was completed where appropriate and is described in a separate report.To review these titles within the Diabetes Strategy Evidence series, please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM: Summary of Evidence-Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics: An Evidence-Based AnalysisBehavioural Interventions for Type 2 Diabetes: An Evidence-Based AnalysisBARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY: An Evidence-Based SummaryCommunity-Based Care for the Management of Type 2 Diabetes: An Evidence-Based AnalysisHome Telemonitoring for Type 2 Diabetes: An Evidence-Based AnalysisApplication of the Ontario Diabetes Economic Model (ODEM) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE: The objective of this report is to determine the efficacy of specialized multidisciplinary community care for the management of type 2 diabetes compared to usual care. CLINICAL NEED: TARGET POPULATION AND CONDITION Diabetes (i.e. diabetes mellitus) is a highly prevalent chronic metabolic disorder that interferes with the body's ability to produce or effectively use insulin. The majority (90%) of diabetes patients have type 2 diabetes. (1) Based on the United Kingdom Prospective Diabetes Study (UKPDS), intensive blood glucose and blood pressure control significantly reduce the risk of microvascular and macrovascular complications in type 2 diabetics. While many studies have documented that patients often do not meet the glycemic control targets specified by national and international guidelines, factors associated with glycemic control are less well studied, one of which is the provider(s) of care. Multidisciplinary approaches to care may be particularly important for diabetes management. According guidelines from the Canadian Diabetes Association (CDA), the diabetes health care team should be multi-and interdisciplinary. Presently in Ontario, the core diabetes health care team consists of at least a family physician and/or diabetes specialist, and diabetes educators (registered nurse and registered dietician). Increasing the role played by allied health care professionals in diabetes care and their collaboration with physicians may represent a more cost-effective option for diabetes management. Several systematic reviews and meta-analyses have examined multidisciplinary care programs, but these have either been limited to a specific component of multidisciplinary care (e.g. intensified education programs), or were conducted as part of a broader disease management program, of which not all were multidisciplinary in nature. Most reviews also do not clearly define the intervention(s) of interest, making the evaluation of such multidisciplinary community programs challenging. EVIDENCE-BASED ANALYSIS METHODS: RESEARCH QUESTIONS: What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a registered nurse, registered dietician and physician (primary care and/or specialist) for the management of type 2 diabetes compared to usual care? [Henceforth referred to as Model 1]What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a pharmacist and a primary care physician for the management of type 2 diabetes compared to usual care? [Henceforth referred to as Model 2] INCLUSION CRITERIA: English language full-reportsPublished between January 1, 2000 and September 28, 2008Randomized controlled trials (RCTs), systematic reviews and meta-analysesType 2 diabetic adult population (>/=18 years of age)Total sample size >/=30Describe specialized multidisciplinary community care defined as ambulatory-based care provided by at least two health care disciplines (of which at least one must be a specialist in diabetes) with integrated communication between the care providers.Compared to usual care (defined as health care provision by non-specialist(s) in diabetes, such as primary care providers; may include referral to other health care professionals/services as necessary)>/=6 months follow-up EXCLUSION CRITERIA: Studies where discrete results on diabetes cannot be abstractedPredominantly home-based interventionsInpatient-based interventions OUTCOMES OF INTEREST: The primary outcomes for this review were glycosylated hemoglobin (rHbA1c) levels and systolic blood pressure (SBP). SEARCH STRATEGY: A literature search was performed on September 28, 2008 using OVID MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) for studies published between January 1, 2000 and September 28, 2008. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Articles with unknown eligibility were reviewed with a second clinical epidemiologist, then a group of epidemiologists until consensus was established. The quality of evidence was assessed as high, moderate, low or very low according to GRADE methodology. Given the high clinical heterogeneity of the articles that met the inclusion criteria, specific models of specialized multidisciplinary community care were examined based on models of care that are currently being supported in Ontario, models of care that were commonly reported in the literature, as well as suggestions from an Expert Advisory Panel Meeting held on January 21, 2009. SUMMARY OF FINDINGS: The initial search yielded 2,116 unique citations, from which 22 RCTs trials and nine systematic reviews published were identified as meeting the eligibility criteria. Of these, five studies focused on care provided by at least a nurse, dietician, and physician (primary care and/or specialist) model of care (Model 1; see Table ES 1), while three studies focused on care provided by at least a pharmacist and primary care physician (Model 2; see Table ES 2). Based on moderate quality evidence, specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinically significant reduction in HbA1c of 1.0% compared with usual care. The effects of this model on SBP, however, are uncertain compared with usual care, based on very-low quality evidence. Specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinically significant reduction in both HbA1c of 1.05% (based on high quality evidence) and SBP of 7.13 mm Hg (based on moderate quality evidence) compared to usual care. For both models, the evidence does not suggest a preferred setting of care delivery (i.e., primary care vs. hospital outpatient clinic vs. community clinic). Table ES1:Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 1OutcomeEstimate of effect(95% CI)Heterogeneity I(2)(p-value)GRADEGlycosylated Hemoglobin (HbA1c [%])-1.00 [-1.27, -0.73]4% (p=0.37)Moderate-quality Subgroup: Moderate-to-High Quality-0.91 [-1.19, -0.62]0% (p=0.74)Systolic Blood Pressure (mm Hg)-2.04 [-13.80, 9.72]89% (p=0.002)Very-low quality*Mean change from baseline to follow-up between intervention and control groupsTable ES2:Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 2OutcomeEstimate of effect(95% CI)Heterogeneity I(2)(p-value)GRADEGlycosylated Hemoglobin (HbA1c [%])-1.05 [-1.57, -0.52]0% (p=0.75)High-qualitySystolic Blood Pressure (mm Hg)-7.13 [-11.78, -2.48]46% (p=0.17)Moderate quality*Mean change from baseline to follow-up between intervention and control groups.  
  Address  
  Corporate Author Health Quality Ontario Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1915-7398 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:23074528 Approved no  
  Call Number refbase @ user @ Serial 7795  
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Author (up) url  openurl
  Title Sound Medication Therapy Management Programs, Version 2.0 with validation study Type Journal Article
  Year 2008 Publication Journal of Managed Care Pharmacy : JMCP Abbreviated Journal J Manag Care Pharm  
  Volume 14 Issue 1 Suppl B Pages S2-44  
  Keywords Drug Therapy/economics/methods; Education, Pharmacy, Continuing/methods; Humans; Managed Care Programs/economics/*standards; Medicare/economics; Medication Therapy Management/organization & administration/*standards; Questionnaires; Reproducibility of Results; Research Personnel/standards; United States  
  Abstract BACKGROUND: The Academy of Managed Care Pharmacy (AMCP, the Academy) contracted with the National Committee for Quality Assurance (NCQA) to conduct a field study to validate and assess the 2006 Sound Medication Therapy Management Programs, Version 1.0 document. Version 1.0 posits several principles of sound medication therapy management (MTM) programs: they (1) recruit patients whose data show they may need assistance with managing medications; (2) have health professionals who intervene with patients and their physicians to improve medication regimens; and (3) measure their results. The validation study determined the extent to which the principles identified in version 1.0 are incorporated in MTM programs. OBJECTIVE: The method was designed to determine to what extent the important features and operational elements of sound MTM programs as described in version 1.0 are (1) acceptable and seen as comprehensive to users, (2) incorporated into MTM programs in the field, (3) reflective of the consensus group's intentions, and (4) in need of modification or updating. SUMMARY: NCQA first conducted Phase One, in which NCQA gathered perspectives on the principles in the consensus document from a mixed group of stakeholders representing both providers and users of MTM programs. Phase Two involved a deeper analysis of existing programs related to the consensus document, in which NCQA conducted a Web-based survey of 20 varied MTM programs and conducted in-depth site visits with 5 programs. NCQA selected programs offered by a range of MTM-providing organizations -- health plans, pharmacy benefit management companies, disease management organizations, and stand-alone MTM providers. NCQA analyzed the results of both phases. The Phase Two survey asked specific questions of the programs and found that some programs perform beyond the principles listed in version 1.0. NCQA found that none of the elements of the consensus document should be eliminated because programs cannot perform them, although NCQA suggested some areas where the document could be more expansive or more specific, given the state of MTM operations in the field. The important features and operational elements in the document were categorized into the following 3 overall categories, which NCQA used to structure the survey and conduct the site visits in Phase Two: (1) eligibility and enrollment, (2) operations, and (3) quality management. CONCLUSIONS/RECOMMENDATIONS: NCQA found that the original consensus document was realistic in identifying the elements of sound MTM. In the current project, NCQA's purpose was not to make judgments about the effectiveness of MTM programs in general or any individual program in particular. NCQA recommended that the consensus document could be made stronger and more specific in 3 areas: (1) specifically state that the Patient Identification and Recruitment section advocates use of various eligibility criteria that may include, but are not limited to, Medicare-defined MTM eligibility criteria; (2) reframe or remove the statement in Appendix A of the consensus document that the preferred modality for MTM is face-to-face interaction between patient and pharmacist, unless there are comparative data to support it as currently written; and (3) specifically recommend that programs measure performance across the entire populations in their plans in addition to measuring results for those patients selected into MTM. This will make benchmarking among programs possible and will lead to substantiated best practices in this growing field.  
  Address  
  Corporate Author Academy of Managed Care Pharmacy Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1083-4087 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:18240889 Approved no  
  Call Number refbase @ user @ Serial 7977  
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Author (up) url  openurl
  Title 5 questions to help your pharmacist help you Type Journal Article
  Year 2007 Publication Heart Advisor / the Cleveland Clinic Abbreviated Journal Heart Advis  
  Volume 10 Issue 4 Pages 10-11  
  Keywords Drug Interactions; Drug Storage; Food-Drug Interactions; Humans; *Patient Education as Topic; *Pharmaceutical Preparations/administration & dosage/adverse effects; *Pharmacists  
  Abstract  
  Address  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1523-9004 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:17500086 Approved no  
  Call Number refbase @ user @ Serial 8129  
Permanent link to this record
 

 
Author (up) url  doi
openurl 
  Title The MEDMAN study: a randomized controlled trial of community pharmacy-led medicines management for patients with coronary heart disease Type Journal Article
  Year 2007 Publication Family Practice Abbreviated Journal Fam Pract  
  Volume 24 Issue 2 Pages 189-200  
  Keywords Aged; *Community Pharmacy Services; Coronary Artery Disease/*drug therapy; England; Female; Health Status; Humans; Male; Medication Systems/*organization & administration; Middle Aged; Pharmacists; Professional Role; Questionnaires  
  Abstract BACKGROUND: There have been recent moves to extend the role of the community pharmacist to include medicine management. METHODS: A randomized controlled trial was conducted in nine sites in England. Patients with coronary heart disease were identified from general practice computer systems, recruited and randomized (2:1) to intervention or control. The 12-month intervention comprised an initial consultation with a community pharmacist to review appropriateness of therapy, compliance, lifestyle, social and support issues. Control patients received standard care. The primary outcome measures were appropriate treatment [derived from the National Service Framework (NSF)], health status (SF-36, EQ-5D) and an economic evaluation. Secondary outcome measures were patient risk of cardiovascular death and satisfaction. RESULTS: The study involved 1493 patients (980 intervention and 513 control), 62 pharmacists and 164 GPs. No statistically significant differences between intervention and control groups were shown at follow-up for any of the primary outcome measures such as numbers on aspirin or lifestyle measures. There were few differences in quality of life (SF-36) between the intervention and control groups at baseline or follow-up or with overall EQ-5D score over time. The total National Health Service cost increased between baseline and at 12 months in both groups but to a greater extent in the intervention group. Significant improvements were found in the satisfaction score for patients' most recent pharmacy visit for prescription medicines among the intervention group, compared with control group. Self-reported compliance was good for both groups at baseline and no significant differences were shown at follow-up. CONCLUSION: There was no change in the proportion of patients receiving appropriate medication as defined by the NSF. The pharmacist-led service was more expensive than standard care.  
  Address Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, UK  
  Corporate Author Community Pharmacy Medicines Management Project Evaluation Team Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0263-2136 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:17272285 Approved no  
  Call Number refbase @ user @ Serial 8175  
Permanent link to this record
 

 
Author (up) url  openurl
  Title Survey: nurses speak up about hospital pharmacists Type Journal Article
  Year 2006 Publication Rn Abbreviated Journal Rn  
  Volume 69 Issue 1 Pages 20  
  Keywords *Attitude of Health Personnel; Conflict (Psychology); Cooperative Behavior; Health Services Needs and Demand; Humans; *Interprofessional Relations; Nursing Staff, Hospital/*psychology; Pharmacists/*psychology; Professional Role; Questionnaires  
  Abstract  
  Address  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0033-7021 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:16440999 Approved no  
  Call Number refbase @ user @ Serial 8374  
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