(63) Community Pharmacist-Led Interventions and Their Impacts on Patients with Type 2 Diabetes in Low-and Middle-Income Countries: A Scoping Review

Publication Number: 1108

Background: Studies assessing community pharmacist-led interventions conducted in high-income countries indicate that community pharmacists have various opportunities to support diabetes management. It is not yet clear to what extent this is also true for low- and middle-income countries (LMICs).

Objectives: To provide an overview of the types of interventions performed by community pharmacists and describe their impacts on patients with type 2 diabetes mellitus (T2DM) in LMICs.

Methods: This review was conducted according to the PRISMA-Scr guidelines (Open Science Framework (OSF) with registration DOI: 10.17605/OSF.IO/VBRM6). PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for (non-) randomised controlled studies, before-after studies, and interrupted time series. There was no restriction in the publication language. Included interventions had to be delivered by community pharmacists solely or collaboratively with other health care professionals in primary care and community settings. The study quality was assessed using the National Institute of Health (NIH) tools. Descriptive analysis was applied.

Results: Twenty-eight studies across 14 countries in LMICs were included representing 4,434 patients (mean age ranging from 47.4 to 59.5 years, 57.7% female). There were single-component and multiple-component interventions, which varied on many key aspects such as frequency of interventions and follow-up time. Face-to-face counseling was the most common intervention used, which was often combined with providing printed materials, remote consultations, or medication reviews. Most studies found improvements in the intervention group for most outcomes, including clinical outcomes (HbA1c, fasting blood glucose, blood pressure, lipid profile, body mass index), patient-reported outcomes (quality of life, medication adherence, diabetes knowledge, patients’ satisfaction), and medication safety (identifying and resolving drug-related problems and adverse drug event). Most studies had poor quality across at least one domain, with heterogeneity among studies.

Conclusions: Community pharmacist-led interventions in LMICs had positive effects on T2DM patients but the quality of many studies was low. Face-to-face counseling of varying intensity, often combined with other strategies, was the most common type of intervention. These findings support the expansion of the role of the community pharmacists in diabetes care in LMICs.