Pharmacist-led motivational interviewing for diabetes medication adherence in a worksite wellness program.

OBJECTIVE: The primary objective was to evaluate the impact of a pharmacist-delivered motivational interviewing (MI) intervention for diabetes medication adherence; the secondary objectives were to assess the changes in clinical outcomes and health-related quality of life (HRQoL). METHODS: A quasi-experimental intervention study was conducted with baseline, postintervention, and follow-up data collections. The study duration was 6 months. Pharmacists trained in MI delivered 3 face-to-face encounters using MI-based semistructured conversation tools to address barriers or challenges to medication adherence. A diabetes worksite wellness program (WWP) at a 350-bed regional hospital in the southeastern United States was the setting, and the study participants were WWP employees or dependents (with type 1 diabetes or type 2 diabetes). The primary outcome was a change in self-reported diabetes medication adherence; the secondary outcomes included the changes in clinical indicators (glycated hemoglobin [HbA1c], blood pressure, and depressive symptoms), and HRQoL. The measures included the Medometer, Summary of Diabetes Self-Care Activities-Medication Subscale (SDSCA-MS), Audit of Diabetes-Dependent QoL (ADDQoL-19), and the Short Form-12 (SF-12) health survey. RESULTS: Fifty-three WWP participants enrolled, and 36 completed the full intervention protocol. Medication adherence (through the Medometer) demonstrated statistically significant improvement after the intervention (P = 0.010); the SDSCA-MS score improved, but was not statistically significant. The change in diastolic blood pressure was statistically significant (P = 0.034), but the changes in HbA1c, systolic blood pressure, presence of depressive symptoms, and ADDQoL-19 were not statistically significant. The SF-12 physical component summary (PCS) and mental component summary (MCS) scores were statistically significant: PCS, P = 0.003, and MCS, P = 0.025. CONCLUSION: The findings from this pilot study support the effectiveness of a pharmacist-delivered, semistructured MI-based intervention for medication adherence in persons with diabetes in a hospital-based WWP. Pharmacists can support patients' behavior change using MI communication skills to explore salient barriers to medication adherence and to facilitate goal setting to overcome these in encounters aimed at shared clinical and behavioral decision-making.

Diabetes Self-Management Education and Medical Nutrition Therapy: A Multisite Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions in the Management of Glycemic Control and Diabetic Dyslipidemia through Retrospective Chart Review.

BACKGROUND: Diabetes self-management education (DSME) and medical nutrition therapy (MNT) improve glycemic control and reduce risk of chronic comorbid disease. OBJECTIVE: Document outcomes for patients with type 2 diabetes (T2D) completing DSME and MNT through American Diabetes Association-recognized programs. DESIGN: Descriptive, retrospective chart review. PARTICIPANTS/SETTING: Four random samples of 100 records of patients with T2D completing DSME and MNT at each of four regional centers in Alabama, June 2013 to 2014, were chosen for review; after exclusions, 392 records were retained. OUTCOME MEASURES: Weight, body mass index (BMI), hemoglobin A1c (HbA1c), total cholesterol, low-density lipoprotein, high-density lipoproteins (HDL), triglycerides (TG), and TG-to-HDL ratio. ANALYSIS: Mixed-model analysis of variance was used to determine differences between continuous variables. McNemar test was used to assess frequency of patients reaching glycemic targets. Paired t tests were used to determine significance of lipid parameters. RESULTS: Significant reductions were observed at end of program and 1 year in weight (2.67±5.54 kg, P<0.001; 2.25±5.45 kg, P=0.001), BMI (0.93±1.91, P<0.001; 0.76±1.93, P=0.001), and HbA1c (1.82%±2.23%, P<0.001; 1.22%±2.15%, P<0.001). Patients managed by diet alone had a mean baseline HbA1c of 6.95% and exhibited a 0.8% reduction in HbA1c (P<0.001) at end of program. Those managed with diet plus drug therapy had a baseline HbA1c of 9% and exhibited a 2.09% reduction in HbA1c (P<0.001). Following DSME and MNT, 62% of patients reached glycemic targets (HcA1c≤7%), as compared with 32% at baseline (P<0.001). Significant reductions in TG were observed from baseline (162±74 mg/dL [4.19±1.91 mmol/L]) to follow-up (109±36 mg/dL [2.82±0.92 mmol/L]) (P<0.001). HDL increased from baseline (45±13 mg/dL [1.16±0.34 mmol/L]) to follow-up (48±11 mg/dL [1.24±0.28 mmol/L]) (P=0.05). The TG-to-HDL ratio improved from a baseline of 4.07±2.41 to 2.48±1.26 at follow-up (P<0.001). CONCLUSIONS: Reductions were observed in weight, BMI, HbA1c, TG, and TG-to-HDL ratio. Improved patient outcomes were achieved in the clinical setting and support universal coverage to increase patient access to DSME and MNT.

Diabetes Self-Management Education and Medical Nutrition Therapy Improve Patient Outcomes: A Pilot Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions through Retrospective Chart Review.

BACKGROUND: Diabetes self-management education (DSME) and medical nutrition therapy (MNT) improve patient outcomes; poor reimbursement limits access to care. OBJECTIVE: Our aim was to develop methodology for tracking patient outcomes subsequent to registered dietitian nutritionist interventions, document outcomes for patients with type 2 diabetes attending an American Diabetes Association-recognized program, and obtain outcome data to support reimbursement and public policy initiatives to improve patient access to DSME and MNT. DESIGN: Retrospective chart review. PARTICIPANTS/SETTING: A random sample of 100 charts was chosen from the electronic medical records of patients with type 2 diabetes completing DSME and individualized MNT, June 2013 to 2014. OUTCOME MEASURES: Data were extracted on body mass index (calculated as kg/m2), weight, hemoglobin A1c, blood glucose, and lipids. STATISTICAL ANALYSIS: Mixed-model analysis of variance was used to determine differences between means for continuous variables; McNemar's tests and γ-statistic trend analysis were used to assess frequency of patients reaching glycemic targets. RESULTS: Significant weight loss was observed from baseline (94.3±21.1 kg) to end of program (91.7±21.2 kg [-1.6±3.9 kg]; P<0.001); weight loss in whites (-5.0±8.4 kg; P<0.001) exceeded that of African Americans (-0.8±9.0 kg; P>0.05). Significant hemoglobin A1c reduction was observed from baseline (8.74%±2.30%) to end of program (6.82%±1.37% [-1.92%±2.25%]; P<0.001) and retained at 1 year (6.90%±1.16%; P<0.001). Comparatively, 72% of patients reached hemoglobin A1c targets (≤7.0%) vs 27% at baseline (P=0.008). When stratified by diet alone and diet plus drug therapy, patients exhibited a 1.08%±1.20% (P<0.001) and 2.36%±2.53% (P<0.001) reduction in hemoglobin A1c, respectively. Triglycerides decreased from baseline 181.6±75.5 mg/dL (2.0±0.9 mmol/L) to 115.8±48.1 mg/dL (1.3±0.5mmol/L) (P=0.023). High-density lipoprotein increased from 41.4±12.4 mg/dL (1.1±0.3 mmol/L) to 47.3±12.4 mg/dL (1.2±0.3 mmol/L) (P=0.007). CONCLUSIONS: Retrospective chart review provides an operational model for abstracting existing patient outcome data subsequent to registered dietitian nutritionist interventions. In support of universal reimbursement and patient access to DSME with supplemental individualized MNT, reductions were observed in key outcome measures weight, body mass index, hemoglobin A1c, and triglycerides.