The adherence of type 2 diabetes mellitus (DM2) patients with an individual care plan\n(ICP) is often not satisfactory, nor does it allow for a significant improvement in outcome, because of\npoor accessibility to services, poor integration of pathway articulations, poor reconciliation with the\npatientâ??s life, or the lack of a constant reference person. The purpose of this study was to evaluate\nthe contribution of community pharmacists and pharmacy services in improving adherence with\nperiodic controls in DM2. The study was conducted at a rural pharmacy. A sample of 40 patients\nwas calculated with respect to a historical cohort and subsequently enrolled. Clinical and personal\ndata were collected in an electronic case report form. Pharmacists acting as a case manager followed\npatients carrying out their ICP developed by an attending physician. Some of the activities foreseen\nby the ICP, such as electrocardiogram, fundus examination, and self-analysis of blood and urine,\nwere carried out directly in the pharmacy by the pharmacist through the use of telemedicine services\nand point of care units. Activities that could not be performed in the pharmacy were booked by the\npharmacist at the accredited units. Examination results were electronically reported by the pharmacist\nto the attending physician. The primary endpoint was the variation in patient adherence with the\nICP compared to a historical cohort. Secondary endpoints were variation in waiting time for the\nexaminations, mean percentage change in glycated hemoglobin (HbA1c) and low-density lipoprotein\n(LDL) cholesterol levels and blood pressure, impact on healthcare-related costs, and perceived quality\nof care. Adherence to the ICP significantly increased. Waiting times were reduced and clinical\noutcomes improved with conceivable effects on costs. Patients appreciated the easier access to services.\nCommunity pharmacists and pharmacy services represent ideal actors and context that, integrated\nin the care network, can really favor ICP adherence and obtain daily morbidity reduction and cost\nsavings through proper disease control and an early diagnosis of complications.
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