Effect Evaluation Of Three Dimensions(Effectiveness,economy And Humanity)of Medical Therapy Management For Type 2 Diabetes Patients Based On Outpatient Pharmaceutical Care

Objective:Diabetes mellitus is a chronic complex disease characterized by elevated blood glucose and a series of metabolic symptoms.The awareness rate,treatment rate and control rate of type 2 diabetes control in China are far lower than the level of developed countries,mainly due to patients’poor disease awareness,low medication compliance,unsuitable treatment plan and poor self-control ability.This study is based on outpatient of a general hospital in patients with type 2 diabetes medication therapy management,to provide medication education,pharmaceutical advice and pharmaceutical care.To explore the effectiveness of pharmacists in improving the disease cognition of type 2 diabetes patients,optimizing the hypoglycemic drug treatment plan and improving the ability of disease self-control.The cost-effectiveness benefit of pharmacists in drug therapy management is analyzed to reflect the important position and value of pharmacists in medication therapy management of type 2 diabetes patients,providing reference for the establishment of reasonable medical insurance cost control and pharmaceutical service fee standards,and promoting rational drug use.Methods:（1）A questionnaire survey on disease and medication is conducted for patients with type2 diabetes who visit the outpatient department in Erdos Central Hospital from June 2020to September 2021.Medication education and guidance are carried out according to the questionnaire results,so as to improve the disease awareness rate of patients with type 2diabetes and improve their disease control ability.（2）Pharmacists carry out medication treatment management services for type 2 diabetes patients and conduct their own control studies to evaluate the efficacy,economic and humanistic indicators of treatment before and after pharmaceutical intervention.Improvements in glycosylated hemoglobin（Hb A1c）,fasting blood glucose（FBG）,blood glucose after 2 hours（2h PG）,total cholesterol（TC）,low density lipoprotein cholesterol（LDL-C）,disease and drug awareness,cost-effectiveness and patient satisfaction with treatment are included.（3）The concept of hypoglycemic drug intensity is explored,and the changes of hypoglycemic drugs before and after pharmacists’intervention are compared to evaluate their relationship with Hb A_1c.To explore the role and value of pharmacists in drug adjustment and optimization.Results:（1）After 15 months of study,100 patients completed the diabetes disease and drug knowledge questionnaire.The results showed that patients with type 2 diabetes generally had low cognition of disease and drugs,low cognition of Hb A_1cmonitoring and target value（only 18.0%）,71%of patients had glucose monitoring less than 4 times per week,and only 22%of patients were aware of adverse reactions of taking hypoglycemic drugs and conducted self-monitoring.Seventy percent of the patients exercised less than five days a week,and 83%of the patients had a regular diet less than five days a week.（2）Sixty-six patients with type 2 diabetes who met the inclusion and exclusion criteria completed a 3-month self-controlled comparison study respectively.Hb A_1cdecreased from 9.40±4.50%to 8.48±4.74%before and after the pharmacists’intervention,p<0.01.FBG decreased from 10.87±2.63mmol/L to 8.08±3.28mmol/L,p<0.01;2h PG decreased from 13.48±2.96mmol/L to 10.63±3.98mmol/L,p<0.01.Hb A_1crate increased from 6.06%to 18.18%,FBG rate increased from 16.67%to 45.45%,2h PG rate increased from 25.76%to 46.97%.BMI（26.48±6.37kg/m²vs 26.29±6.43kg/m²,p=0.1489）,TC（4.39±3.66μmol/L vs 4.20±3.04μmol/L,p=0.7462.）and LDL-C（2.69±2.30μmol/L vs2.57±2.46μmol/L,p=0.7727.）had no statistically significant.Patients’blood glucose management with pharmacists’intervention had cost-effectiveness benefits.After pharmacists’intervention,the cost of Hb A_1cdecreased by 1%was 173.84 yuan,FBG decreased by 1mmol/L was 61.75 yuan,and 2h PG decreased by 1mmol/L was 56.31 yuan.In terms of human indicators,the score of disease and drug cognition of patients increased from 47.42±10.97 points before intervention to 63.29±11.26 points（p<0.01）,and the cognitive degree increased from low to medium（score≥60points）,indicating that pharmaceutical care could significantly improved the disease and drug cognition of diabetes patients.The patients’satisfaction with diabetes treatment was 80.88%.（3）The intensity of hypoglycemic drugs in patients before and after pharmacists’intervention was（2.97±2.05）vs（3.27±2.66）,p=0.0873,had no statistically significant,which may be related to the fact that pharmacists had no prescription and couldn’t give full role to adjustment of drug regimen.It also indicated that pharmacists can play the role of blood glucose control in patients with type 2 diabetes through other pharmaceutical care other than drugs.Conclusions:Pharmacists carry out medication therapy management services for out-patient type 2 diabetes patients,which can significantly improve patients’cognition of disease and medicine,improve the effectiveness of diabetes treatment,have economic value,and improve patients’treatment satisfaction.In the background of pharmaceutical care model transformation,the concept of hypoglycemic drug intensity is explored in this study to explain the role of pharmacists in the optimization of hypoglycemic drug regimens and explore the construction of pharmaceutical care system,which has practical significance for improving the work efficiency and social value of pharmacists.It provides a basis for establishing standards of medical insurance cost control,pharmacists’service fees and promoting rational drug use,so as to better play the role of pharmacists in drug treatment of diabetes patients.