JMIR Publications

ABSTRACT

Background:

Evidence-based physician-pharmacist collaborative clinics have been shown to significantly improve outcomes for patients with type 2 diabetes (T2D) in a relatively short time, but the long-term effectiveness has been unclear, especially in primary healthcare settings.

Objective:

This study aims to explore the effectiveness and cost-effectiveness of a novel, digital-driven, multifaceted physician-pharmacist collaborative model for the long-term management of patients with type 2 diabetes in under-resourced settings.

Methods:

We conducted a 12-month cluster randomized controlled trial from May 2021 to December 2022 across six primary healthcare settings in China. The intervention involved routine therapy from physicians along with pharmaceutical interventions from pharmacists, combining face-to-face visits and mobile health care which guided by the Theory of Planned Behavior. Intervention group received four face-to-face guidance and biweekly remote education. We conducted intention-to-treat analyses to estimate differences in clinical and behavior indicators between the intervention and control group. Primary outcomes included glycosylated hemoglobin and 10-year atherosclerotic cardiovascular risk, and adjusted generalized estimation equations were used to analysis data.

Results:

This study included 574 patients (291 to the intervention and 283 to the control). Patients in collaborative clinics had significant reductions over 12 months in glycated hemoglobin (-2.57 vs -1.96, P<.001, [95%CI -1.027 to -0.238]), atherosclerotic cardiovascular risk (-1.35 vs 0.01, P<.001, [95%CI -1.690 to -0.630]). Secondary outcomes showed improvements in the intervention group, including fast blood glucose, 2-hour postprandial blood glucose, waist circumference, waist-to-hip ratio, blood pressure, triglyceride, and total cholesterol. Total diabetes-related costs decreased significantly in the intervention group over 12 months, while patient satisfaction improved. There were no significant differences in body mass index, high-density lipoprotein or low-density lipoprotein.

Conclusions:

These findings suggest a promising physician-pharmacist collaborative model to improve the long-term quality and efficiency of T2D management and reduce medical costs in under-resourced areas globally, while patients with T2D, especially those with central obesity or high cardiovascular risk, may benefit more from collaborative clinics. Clinical Trial: clinicaltrials.gov, identifier ChiCTR2000031839.