Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis

BackgroundControl of blood glucose and a reduced risk of complications are important treatment goals in diabetes. Medication non-adherence can influence the outcome of diabetes. Involvement of a pharmacist in diabetes care might help patients to achieve better treatment outcomes. Existing literature reviews have focused on a limited number of interventions and outcome measures, and have involved different healthcare professionals. None of the previous reviews have used a standardized effect size to compare the effects of different pharmacist-led interventions and different outcome measures.ObjectiveTo review pharmacist-led interventions to improve medication adherence in patients with diabetes and to assess the effectiveness of these interventions on medication adherence.MethodsSix databases were systematically searched between March and September 2017 for randomized controlled trials: PubMed, Cochrane library, EMBASE, CINAHL, JSTOR, and Web of Science. The outcome measures used were: medication adherence, HbA1c, fasting plasma glucose (FPG), post-prandial blood glucose (PPG), or random blood glucose (RBG). Cohen's d, a standardized effect size, enabled a comparison of studies with different outcome measures. The Cochrane risk of bias tool was used to assess the quality of the studies.ResultsFifty-nine studies were included in this review. Pharmacist-led interventions enhanced outcomes in patients with diabetes (standardized mean difference (SMD) ?0.68; 95% CI -0.79, ?0.58; p < 0.001). Sub-group analysis by intervention strategy, the type of intervention and outcome measures produced similar results. Further analysis showed that education, printed/digital material, training/group discussion, were more effective than other interventions.ConclusionThis finding supports the role of the pharmacist in diabetes care to enhance medication adherence.