The prevalence of self-monitoring of blood glucose and costs of glucometer strips in a nationwide cohort.

OBJECTIVE: This study used nationwide data to determine the prevalence of self-monitoring of blood glucose (SMBG) among all non-institutionalized persons living in Norway and to estimate the prevalence of SMBG among diabetes patients, the frequency and cost of SMBG, and the use of different glucometers. METHODS: This retrospective, descriptive study is based on data of sales of glucometer strips to non-institutionalized persons in Norway in 2008. The data included gender, age group, month of purchase, sales place, type of strips, number of packages dispensed, and cost of strips. Additionally, statistics on sales of insulin and oral antidiabetes medications were obtained from the Norwegian Prescription Database. RESULTS: A total of 96,999 persons purchased strips, a prevalence of 2%. Approximately 70% of diabetes patients practiced SMBG. An average patient used 1.7 strips per day, and younger patients purchased more strips than older patients. Fewer than 50% of patients performed glucose measurements daily. One percent of patients used more than 10 strips daily and was accountable for 8% of total costs. Most patients used only one type of strips, but the number of strips purchased increased with the number of different strips. The average annual cost of strips was 446 euro per person. CONCLUSIONS: Two percent of all non-institutionalized inhabitants and an estimated 70% of patients using diabetes medication purchased SMBG strips. A small percentage of the patients incurred a substantial proportion of the costs. This, along with the fact that over half of the patients monitor less than once per day, calls for tighter follow-up of diabetes patients.

Quality assessment of patients' self-monitoring of blood glucose in community pharmacies / Evaluación de la calidad de la auto-monitorización de glucosa sanguínea de pacientes en farmacia comunitaria

Objective: To evaluate diabetes patients' self-monitoring of blood glucose using a community pharmacy-based quality assurance procedure, to investigate whether the procedure improved the quality of the patient performance of self monitoring of blood glucose, and to examine the opinions of the patients taking part in the study. Methods: The results of patient blood glucose measurements were compared to the results obtained with HemoCue Glucose 201+ by pharmacy employees in 16 Norwegian community pharmacies. Patient performance was monitored using an eight item checklist. Patients whose blood glucose measurements differed from pharmacy measurements by more than 20% were instructed in the correct use of their glucometer. The patients then re-measured their blood glucose. If the results were still outside the set limits, the control procedure was repeated with a new lot of glucometer strips, and then with a new glucometer. The patients returned for a follow-up visit after three months. Results: During the first visit, 5% of the 338 patients had measurements that deviated from pharmacy blood glucose values by more than 20% and user errors were observed for 50% of the patients. At the second visit, there was no significant change in the analytical quality of patient measurements, but the percentage of patients who made user errors had decreased to 29% (p < 0.001). Eighty-five percent of the patients reported that they used their blood glucose results to adjust medication, exercise or meals. Fifty-one percent of the patients reported a greater trust in their measurements after the second visit. Eighty percent of patients wished to have their measurements assessed yearly. Of these patients, 83% preferred to have the assessment done at the community pharmacy. Conclusion: A community pharmacy-based quality assessment procedure of patients' self monitoring of blood glucose significantly reduced the number of user errors. The analytical quality of the patients´ measurements was good and did not improve further during the study. The high analytical quality might be explained by a selection bias of participating patients. Patients also reported increased confidence in their blood glucose measurements after their measurements had been assessed at the pharmacy (AU)

Objetivo: Evaluar la auto-monitorización de la glucemia de pacientes diabéticos que utilizan un procedimiento de aseguramiento de la calidad en farmacia comunitaria, investigar si el procedimiento mejoró la calidad de la ejecución de la monitorización del paciente, y examinar las opiniones de los pacientes que tomaron parte en el estudio. Métodos: Los resultados de las medidas de glucemia de los pacientes se compararon con los resultados obtenidos con un HemoCue Glucose 201+ por los empleados de la farmacia en 16 farmacias comunitarias noruegas. Se monitorizó la actuación del paciente utilizando un check-list de 8 puntos. Se educó en el uso del glucómetro a los pacientes cuyos valores de glicemia diferían en más de un 20% de los medidos en la farmacia. Después los pacientes volvieron a medir su glucemia. Si los resultados estaban aún fuera de los límites se repetía el procedimiento con un nuevo paquete de tiras de glucómetro, y después con un nuevo glucómetro. Los pacientes volvieron para una visita de seguimiento tres meses después. Resultados: Durante la primera visita, el 5% de los 338 pacientes tuvieron mediciones malas que se desviaron de las de la farmacia en valores superiores al 20% y se observaron errores en el 50% de los pacientes. En la segunda visita, no hubo cambios significativos en la calidad analítica de las medias de los pacientes, pero el porcentaje de usuarios con errores disminuyó al 29% (p<0,001). El 85% de los pacientes informó que utilizaban los resultados de su glucemia para ajustar la medicación, ejercicio o comidas. El 51% de los pacientes informó que tenían una mayor confianza en su medición después de la segunda visita. El 80% de los pacientes deseaba que se le evaluasen sus mediciones de glicemia anualmente. De estos pacientes, el 83% prefería que la evaluación se hiciese en la farmacia comunitaria. Conclusión: Un procedimiento de evaluación de la calidad de la auto-monitorización de glucemia realizado en farmacia comunitaria redujo significativamente el número de errores de los usuarios. La calidad analítica de las medidas de los pacientes fue buena y no mejoró durante el estudio. La alta calidad analítica podría explicarse por un sesgo de selección de los pacientes participantes. Los pacientes también informaron e un aumento de confianza en sus medidas de glucemia después de que sus mediciones fueses evaluadas en la farmacia (AU)

Quality assessment of patients' self-monitoring of blood glucose in community pharmacies.

OBJECTIVE: To evaluate diabetes patients' self-monitoring of blood glucose using a community pharmacy-based quality assurance procedure, to investigate whether the procedure improved the quality of the patient performance of self monitoring of blood glucose, and to examine the opinions of the patients taking part in the study. METHODS: The results of patient blood glucose measurements were compared to the results obtained with HemoCue Glucose 201(+) by pharmacy employees in 16 Norwegian community pharmacies. Patient performance was monitored using an eight item checklist. Patients whose blood glucose measurements differed from pharmacy measurements by more than 20% were instructed in the correct use of their glucometer. The patients then re-measured their blood glucose. If the results were still outside the set limits, the control procedure was repeated with a new lot of glucometer strips, and then with a new glucometer. The patients returned for a follow-up visit after three months. RESULTS: During the first visit, 5% of the 338 patients had measurements that deviated from pharmacy blood glucose values by more than 20% and user errors were observed for 50% of the patients. At the second visit, there was no significant change in the analytical quality of patient measurements, but the percentage of patients who made user errors had decreased to 29% (p < 0.001). Eighty-five percent of the patients reported that they used their blood glucose results to adjust medication, exercise or meals. Fifty-one percent of the patients reported a greater trust in their measurements after the second visit. Eighty percent of patients wished to have their measurements assessed yearly. Of these patients, 83% preferred to have the assessment done at the community pharmacy. CONCLUSION: A community pharmacy-based quality assessment procedure of patients' self monitoring of blood glucose significantly reduced the number of user errors. The analytical quality of the patients' measurements was good and did not improve further during the study. The high analytical quality might be explained by a selection bias of participating patients. Patients also reported increased confidence in their blood glucose measurements after their measurements had been assessed at the pharmacy.

Pharmacists' attitudes towards the reporting of suspected adverse drug reactions in Norway.

BACKGROUND: In Scandinavian countries, pharmacists have not reported adverse drug reactions (ADRs), either due to legislative restrictions or because of lack of tradition. From 1 January 2005, Norwegian pharmacists have been encouraged by the Norwegian Medicines Agency to take a larger role in the reporting of ADRs. OBJECTIVE: To explore pharmacists' attitudes towards pharmacovigilance and their experiences with ADR reporting, to evaluate the effect of an educational programme and to compare these findings to the attitudes in a control group. METHODS: From September 2004, pharmacies in two of Norway's five health regions were invited to attend a 3-month ADR reporting study, and 39 pharmacies were recruited. One pharmacist from each pharmacy participated in a 1 day pre-study educational programme and a 1 day post-study evaluation meeting. Pharmacists involved in the study answered a questionnaire (A) regarding their attitudes to ADR reporting (active group). A control group answered the same questionnaire. One reminder was sent. The active group evaluated the study by answering questionnaire A once more and an evaluation questionnaire (B). Qualitative aspects of ADR reporting were discussed with the active group post-study. RESULTS: The response rate for questionnaire A was 97% (n = 158) in the active group, 74% (n = 184) in the control group and the response rate for questionnaire A and B post-study was 68% (n = 105) in the active group. Pharmacists in the active group had more positive attitudes to ADR reporting after taking part in the study than the control group (p < 0.001). Lack of time, confidence and knowledge of reporting rules could potentially prevent them from reporting ADRs. CONCLUSIONS: The pharmacists had positive attitudes towards pharmacovigilance, but very little experience with reporting. The educational programme clarified their role and increased their knowledge about the reporting requirements.

Patients' understanding and management of their illnesses and prescribed medicines--a descriptive study.

OBJECTIVE: The objective of this study was to explore patients' understanding and management of their illnesses and prescribed medicines. METHOD: Patients receiving three or more repeat prescription drugs were interviewed in their homes after their repeat prescriptions had drug-related problem (DRP) identified by a community pharmacist in a GP surgery. RESULTS: In total, 58 patients were interviewed. Patients distinguished strongly between 'forgetting' and 'taking less' of their medicines, and some actively reduced the dose themselves. More than 25% of the patients involved their spouse in the administration of their medicines. Patients had more worries about their illness (48%) than their medicines (31%). Any changes made to their present medication, or introduction of new medicines, were thought to 'upset the balance'. CONCLUSION: More information is needed on patients' perspectives, both on side effects, compliance and how to deal with long-term medication. Health care professionals should seek to understand and respect patients' choices to assure optimal care.