Community Pharmacist-Led Interventions in Patients with Type 2 Diabetes
in Low-and Middle-Income Countries: A Scoping Review
Abstract
Aims. To provide an overview of the types of interventions performed by
community pharmacists and describe their effects on patients with type 2
diabetes mellitus (T2DM) in low- and middle-income countries (LMICs).
Methods. This review was conducted according to the PRISMA-Scr
guidelines. PubMed, EMBASE, and the Cochrane Central Register of
Controlled Trials were searched for (non-) randomized controlled,
before-after, and interrupted time series design. There was no
restriction in the publication language. Included interventions had to
be delivered by community pharmacists in primary care and community
settings. The study quality was assessed using the National Institute of
Health tools. Results were analyzed descriptively. Results. Twenty-eight
studies were included representing 4,434 patients (mean age from 47.4 to
59.5 years, 55.4% female). Four studies were single- and the remaining
studies were multiple-component interventions. Face-to-face counseling
of patients was the most common intervention, often combined with
providing printed materials, remote consultations, or conducting
medication reviews. Generally, studies showed improved outcomes in the
intervention group, including clinical, patient-reported and medication
safety outcomes. In most studies at least one domain was judged to be of
poor quality, with heterogeneity among studies. Conclusions. Community
pharmacist-led interventions among T2DM patients showed positive effects
in LMICs, but the quality of the evidence was poor. Face-to-face
counseling of varying intensity, often combined with other strategies,
was the most common type of intervention. Although these findings
support the expansion of the role of the community pharmacist in
diabetes care in LMICs, better quality studies are needed to evaluate
further impact.