Perceived diabetes status is independently associated with glucose monitoring behaviour among type 2 diabetes mellitus patients.

AIMS: To investigate if patients' perceptions of their diabetes status is related to blood glucose self-monitoring (SMBG) behaviour, independent of self-reported disease severity. METHODS: The setting of this study was a cross-sectional study among 1561 patients, 18 years or older, who filled at least two prescriptions for any glucose lowering drug between March 2002 and 2003 in the Netherlands. Using a 30-item self-administered questionnaire, data on self-monitoring behaviour (frequency of test strip use and objective of self-monitoring), perceived diabetes status and disease severity were gathered. Type 1 diabetes mellitus patients were excluded. We used logistic regression to calculate odds ratios (OR) and their 95% confidence intervals (CI). RESULTS: About 54% of the patients (n=841) returned evaluable questionnaires. After exclusion of 97 type 1 diabetes mellitus patients, 744 type 2 diabetes mellitus patients were included. Practising SMBG was more common among patients who rated their diabetes status as poorly or moderately controlled compared to those who rated it (very) well-controlled (OR 1.93; 95% CI: 1.20-3.12). A better perceived diabetes status was more likely in those who performed SMBG infrequently compared to those who performed SMBG frequently (p-value for trend=0.001). Self-reported factors of disease severity and personalized objectives did not affect these associations considerably. CONCLUSIONS: Among type 2 diabetes mellitus patients, SMBG behaviour is associated with patients' perceptions of diabetes status, irrespective of the self-reported disease severity.

Differences in the association between structural factors and diabetes self-monitoring support.

OBJECTIVE: To determine if the association between the level of community pharmacy diabetes services and six of its reported determinants is influenced by the definition of these services. METHOD: Cross-sectional survey among 97% of all Dutch community pharmacies (1,642) registered in 2004. Seven definitions of self-monitoring support (support to patients performing self-monitoring of blood glucose) were constructed: one based on the Dutch pharmacy practice guideline (containing five activities related to patient counselling, calibration and dispensing), one based on patient counselling activities only and five definitions based on each separate activity. Multivariable models of self-monitoring support according to the different definitions were compared. MAIN OUTCOME MEASURE: Associations between determinants and the different definitions of self-monitoring support, expressed as odds ratio (OR) and 95% confidence intervals (95% CI). All definitions were compared to the practice guideline definition. RESULTS: The ORs of 14 of the 48 possible comparisons of different definitions were significantly different from one. The standardized difference ranged from 1.42 (95% CI: 1.01-1.90) to 3.05 (95% CI: 1.51-4.61). Three out of six predictive models retained different determinants compared to the multivariable model of self-monitoring support based on the guideline. CONCLUSION: The association between self-monitoring support and its determinants depend on the definition of self-monitoring support. This underlines the importance for pharmacy practice research to unambiguously describe the characteristics and the setting of an intervention. Only with a complete description of the intervention, the likelihood for success of implementation in another setting can be determined.

Regional influences on the dispensing of glucose test strips in Dutch community pharmacies.

BACKGROUND: Pharmacy practice guidelines promote the role of community pharmacies in self-monitoring of blood glucose. However, variations between Dutch pharmacies exist in the proportion of patients to whom test strips are dispensed. OBJECTIVE: To assess whether variations between community pharmacies in dispensing of blood glucose test strips can be explained by differences in patient characteristics and the region in which the pharmacy is located. SETTING: PHARMO-Record Linkage System containing drug dispensing histories from 40 community pharmacies of about 450,000 patients in the Netherlands. METHOD: We performed a retrospective cohort study. Data on prescription of all drugs and medical aids between 1991 and 2001 were extracted for all new users of antidiabetic drugs. Patients were excluded if the dispensing history did not allow classification of the type of diabetes or if the dispensing pharmacy could not be determined. The data were analysed using a Cox proportional hazard model. MAIN OUTCOME MEASURE: Time to first test strips dispensed. RESULTS: We identified 8,233 starters of antidiabetic drugs. During a median follow-up of 2.1 years, 20% of the patients were dispensed test strips at least once. Community pharmacy was significantly associated with the dispensing of test strips after adjustment for patient characteristics. This association was less apparent when stratified for the geographical location of the pharmacy. CONCLUSION: Community pharmacy is an independent determinant of the start of use of test strips. Differences in dispensing of test strips between pharmacies are dependent on geographical region. This suggests that implementing practice guidelines for diabetes care in community pharmacy requires different approaches in different regions.

Collaborative services among community pharmacies for patients with diabetes.

BACKGROUND: Patients performing self-monitoring of blood glucose (SMBG) may benefit from community pharmacy services. However, wide-scale implementation of these services is limited. Many pharmacy characteristics (eg, physical layout of the pharmacy, knowledge and competence of the pharmacy team) are reported to be relevant when implementing these services. Still, the importance of local agreements on the division of roles with, for example, local general practitioners or diabetes nurses, is less clear. OBJECTIVE: To study the association between local collaboration and the level of services provided by community pharmacies to patients performing SMBG. METHODS: In 2004, we performed a cross-sectional survey among all 1692 Dutch community pharmacies. Data were gathered on provision of services for SMBG, local agreements, and pharmacy characteristics. Data were analyzed using logistic regression. Associations were adjusted for pharmacy characteristics. RESULTS: About 44% (724) of the community pharmacies returned the questionnaire. Pharmacies that were not involved in local collaborative services on patient counseling reported to provide fewer services compared with those that were involved in such agreements (OR 0.26, 95% CI 0.13 to 0.53). Similar findings were observed for agreements on calibration of SMBG equipment (0.17, 0.04 to 0.71). The associations remained after adjusting for pharmacy characteristics. CONCLUSIONS: Local collaboration on the division of roles in diabetes care between healthcare professionals is independently associated with the number of pharmacy services provided to patients performing SMBG.

Dispensing glucose test materials in Dutch community pharmacies.

OBJECTIVE: To assess the proportion of diabetic patients who collect self-monitoring equipment for glucose testing in Dutch community pharmacies. METHODS: Data were used from the PHARMO-Record Linkage System, containing pharmacy dispensing records from 1991 to 1998. The study population consisted of patients who received at least two prescriptions of insulin and/or oral hypoglycemic agents. Information was collected on patient demographics, antidiabetic drug use and self-monitoring equipment (blood glucose meters and test strips). Type of diabetes was determined for all incident users of antidiabetic drugs. MAIN OUTCOME MEASURE: The proportion of patients per community pharmacy, who were dispensed self-monitoring equipment at least once. RESULTS: The study population consisted of 11,358 diabetic patients. The number of incident patients was 5,050, of whom 91.7% had type 2 diabetes. Twenty-nine pharmacies were included. The mean proportion of patients per pharmacy who received test strips at least once was 30.1% (SD = 6.7%), range 19-46%. The proportion of patients who were dispensed test strips was almost three times higher among type 1 than among type 2 patients (54% vs. 17%). CONCLUSION: In comparison to other countries' published data, Dutch community pharmacies dispense relatively few glucose test materials to diabetic patients. There are substantial differences between pharmacies in dispensing test strips. Further research is needed into the determinants governing the use of test strips at both patient and pharmacy level.