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2. Master Thesis / Tesis Master
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Title:	Clinical outcome and pharmacoeconomic study of a pharmacist-managed diabetes clinic.
Authors:	Tan Pik Seng (P43493)
Supervisor:	Professor Dr. P.T. Thomas
Keywords:	Diabetes mellitus (DM) Pharmaceutical care (PC) Diabetes knowledge Diabetes Mellitus-economic
Issue Date:	2-Aug-2011
Description:	The incidence of diabetes mellitus (DM) is increasing in Malaysia. Despite tremendous increase in our knowledge of this chronic disease and an increase in the drugs available for its treatment, morbidity and mortality due to diabetes and its complications continues to increase. The aim of this research was to assess the short term clinical, humanistic and economic outcomes of pharmaceutical care (PC) for patients with type 2 DM. A total of 222 patients were enrolled at Serdang Hospital and randomised into intervention and control group. Patients in the intervention group (n = 111) received pharmaceutical care, whereas patients in the control group (n = 111) received only the normal pharmacy service. A range of clinical outcomes and economic measures were collected and evaluated at baseline and at sixth month. There were no significant differences in demographic variables at baseline between the intervention and the control group. Significant reductions (p < 0.05) in mean values (baseline vs. 6-month; mean ± S.D.) of HbA1c (9.93 ± 1.76% vs. 8.83 ± 1.85%), systolic blood pressure (135 ± 17 mmHg vs. 127 ± 12 mmHg), diastolic blood pressure (81 ± 8 mmHg vs. 78 ± 8 mmHg), total cholesterol (4.87 ± 1.20 mmol/L vs. 4.51 ± 0.86 mmol/L), triglyceride (1.68 ± 0.78 mmol/L vs. 1.57 ± 0.60 mmol/L), lowdensity lipoprotein (LDL) cholesterol (2.93 ± 0.97 mmol/L vs. 2.66 ± 0.76 mmol/L), and significant increase in diabetes knowledge (80.90 ± 15.71% vs. 91.30 ± 10.84%), medication adherence score (2.53 ± 1.91 vs. 1.42 ± 1.56), EuroQoL-5 dimensions (EQ-5D) index score (67.75 ± 10.85% vs. 71.71 ± 10.71%) were observed in the intervention group; no significant changes were noted in the control group. During the PC program, the pharmacist identified 340 PC issues and facilitated 354 PC interventions. More than 190 (55.1%) PC interventions were categorized as clinically significant and 261 (73.7%) PC interventions were accepted by the physicians. Although the total costs per patient were significantly higher for the intervention group (RM681.07 vs. RM542.64; p = 0.014), the cost effectiveness ratios were better in the intervention group (RM619.15 vs. RM3617.60/1% reduction in HbA1c). In conclusion, incorporation of PC into the management of type 2 DM can have a definite, positive impact on patient health care outcomes and lead to more cost effective treatment.,Insiden penyakit diabetis mellitus (DM) semakin meningkat di Malaysia. Walaupun pengetahuan mengenai penjagaan dan ubat-ubatan DM semakin bertambah, morbiditi dan mortaliti akibat diabetis dan komplikasinya terus meningkat. Kajian ini dijalankan bagi menilai keberkesanan penjagaan farmaseutikal (PC) dalam penjagaan penyakit DM jenis II dari segi klinikal, humanistik dan ekonomi. Seramai 222 pesakit telah dipilih di Hospital Serdang dan dibahagikan secara rawak kepada kumpulan intervensi dan kawalan. Kumpulan intervensi (n = 111) menerima penjagaan farmaseutikal, manakala kumpulan kawalan (n = 111) hanya menerima perkhidmatan farmasi yang biasa. Pelbagai ukuran klinikal dan ekonomi dikumpul dan diuji pada awal dan akhir (selepas 6 bulan) kajian. Pada permulaan kajian, tidak terdapat perbezaan signifikan dari segi demografi antara kumpulan intervensi dan kumpulan kawalan. Pada kumpulan intervensi terdapat pengurangan yang signifikan (p < 0.05) ke atas purata ukuran yang dipantau (bacaan awal berbanding akhir; purata ± S.D.) seperti HbA1c (9.93 ± 1.76% berbanding 8.83 ± 1.85%), tekanan darah sistolik (135 ± 17 mmHg berbanding 127 ± 12 mmHg), tekanan darah diastolik (81 ± 8 mmHg berbanding 78 ± 8 mmHg), kolesterol total (4.87 ± 1.20 mmol/L berbanding 4.51 ± 0.86 mmol/L), trigliserida (1.68 ± 0.78 mmol/L berbanding 1.57 ± 0.60 mmol/L) dan kolesterol LDL (2.93 ± 0.97 mmol/L berbanding 2.66 ± 0.76 mmol/L). Peningkatan signifikan ke atas purata skor pengetahuan tentang diabetis (80.90 ± 15.71% berbanding 91.30 ± 10.84%), markah pematuhan kepada ubat-ubatan (2.53 ± 1.91 berbanding 1.42 ± 1.56) serta markah indeks EuroQoL-5 dimensi (EQ-5D) (67.75 ± 10.85% berbanding 71.71 ± 10.71%). Manakala pada kumpulan kawalan tidak ada perubahan yang signifikan dilihat pada akhir kajian berbanding pada awal kajian. Pegawai farmasi berjaya mengenalpasti sebanyak 340 isu PC dan mencadangkan sebanyak 354 intervensi PC. Lebih daripada 190 (55.1%) intervensi dikategorikan sebagai penting dari segi kinikal dan 261 intervensi (73.7%) diterima oleh doktor. Jumlah kos bagi perawatan pesakit untuk kumpulan intervensi lebih tinggi daripada kumpulan kawalan (RM681.07 berbanding RM542.64; p = 0.014). Walau bagaimanapun, kumpulan intervensi mempunyai nisbah keberkesanan kos yang lebih rendah berbanding dengan kumpulan kawalan (RM619. 15 berbanding RM3617.60 bagi setiap 1% penurunan aras HbA1c). Kesimpulannya, penjagaan farmaseutikal amat berpotensi bagi menghasilkan kesan positif dari segi klinikal dan terutamanya efektif dari segi ekonomi di dalam perawatan penyakit DM jenis II.,Master
Pages:	178
Publisher:	UKM, Kuala Lumpur
Appears in Collections:	Faculty of Pharmacy / Fakulti Farmasi

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