Application, Benefits, and Limitations of Telepharmacy for Patients with Diabetes in the Outpatient Setting

Figures & data

Figure 1 Flow chart of literature search.

Table 1 Application, Benefits and Limitations of Telepharmacy in Diabetes Mellitus

Citation	Study Design	Purposes	Model of Pharmaceutical Services	Description of Intervention	Sample Size	Strength	Limitation
Jarab et al (2012), Jordan^Citation37	RCT	To evaluate the impact of clinical pharmacist-led pharmaceutical program on clinical outcomes and self-behaviour	Counseling	Counseling and follow-up via telephone for 8 weeks	156	Significant improvement in the intervention group on fasting blood glucose levels, blood pressure, total cholesterol, LDL-C, serum triglycerides, and medication adherence	There was no significant reduction in smoking behavior due to the lack of interventions given
McFarland et al (2012), USA^Citation41	RCT	To compare the effect of medication therapy management by clinical pharmacy specialist who use Care Coordination Home Telehealth (CCHT) with clinical pharmacist who did not use CCHT	Counseling, home pharmacy care	Monitoring and communication using messaging device to monitor blood glucose and follow-up telephone with clinical pharmacy specialist	103	HbA1c decreased <7% in 69% of the intervention group	Device purchase costs are needed, training and device use training are needed for patients
Odegard et al (2012), USA^Citation17	RCT	To evaluate the impact of intervention on medication adherence for diabetic patients	Counseling	Telephone-initiated adherence support by pharmacist following computer-generated missed refill alerts	265	Telepharmacy made a significant change in the patient’s MPR value at the 12th month of intervention	Not identified
O’Conno r et al (2014), USA^Citation18	RCT	To evaluate the impact of intervention on medication adherence	Home pharmacy care, counseling	Monitoring, follow-up, education and reminders to take medication via telephone for 2–6 weeks	2378	The decrease in HbA1c value and increase in adherence to therapy were not significant between the the intervention group and the control group	Counseling and follow-up via telephone only takes an average of 5 minutes
Olesen et al (2014), Denmark^Citation42	RCT	To investigate the impact of pharmaceutical care on medication adherence, hospitalitation and mortality of elderly	Home pharmacy care, counseling	Visits by the pharmacist for education and telephone follow-up at 3, 6 and 9 months	517	No significant differences in medication adherence, mortality and hospitalisation between intervention and control groups	Prescription by fax does not go well
Jyun et al (2015), Taiwan^Citation34	RCT	To assess change in HbA1c levels and medical expenses	Home pharmacy care, counseling	Monitoring and follow-up treatment via telephone	100	A significant decrease in HbA1C levels	There is no significant reduction in costs
Shane McWhorter et al (2015), USA^Citation24	RCT	To assess clinical outcomes and measurements with the use of telemonitoring device	Home pharmacy care, counselling	Monitoring daily blood glucose and blood pressure, and follow-up phone calls by pharmacist	150	Telepharmacy provides a significant decrease in HbA1c levels reaching 2.07%, increased knowledge about diabetes and compliance with antihypertensive therapy Patient compliance in using telemonitoring tools reached 79.7%	Costs are required to purchase equipment, patients who are rarely exposed to technology can experience difficulties
Jahangard-Rafsanjani et al (2015), Iran^Citation13	RCT	To investigate the efficacy of pharmacist-delivered diabetes support for patients in middle-income country	Counseling and Home pharmacy care	Monthly visits and follow-up calls to strengthen adherence to therapy and resolve drug therapy problems and provide diabetes education (diet, use of blood glucose monitoring devices)	85	Decrease in HbA1c levels in the intervention group up to 1.0% ± 1.5% Self-care activity increases in diet, blood glucose monitoring, and foot care Significant improvement in medication adherence and BMI	Not identified
Aguiar et al (2016), Brazil^Citation33	RCT	To evaluate the effect of a pharmacist-physician collaborative care model on clinical outcomes for patients with uncontrolled type 2 diaates	Home-care Pharmacy and Counseling	Telephone consultation, and monitoring medication therapy adherence	80	Counseling and monitoring of therapy resulted in significant improvement in clinical assessment (HbA1C, and blood sugar,) with no change in the consumption of anti-diabetic drugs	Not identified
Lee et al (2017), Malaysia^Citation40	RCT	To examine the effects of telemonitoring program with feedback in type 2 diabetes mellitus patients fasting during Ramadhan	Home pharmacy care	Using a web-enabled glucometer (MyGlucoHealth) to monitor patient’s blood glucose and messages alert	85	In the intervention group, patients had lower hypoglycaemia situation, and decrease in HbA1c reaching 1.07%.	Training and guidance is required for the use of tools, the cost of purchasing tools
Lyons et al (2017), UK^Citation16	RCT	To test the effectiveness of pharmacist-led service to improve medication adherence	Counseling and Home pharmacy care	Telephone consultation with pharmacist, medicines reminder chart	677	Medication adherence reached ≥90% in the intervention group, Achievement of HbA1c values (<7%) reached 66.7%	Not identified
Siaw et al (2017), Taiwan^Citation45	Randomized controlled cross-over study	To evaluate the impact of mHealth clinical pharmacist on HbA1c, blood pressure and LDL in African-American and Latinos diabetic patients	Counseling	Phone consultation with clinical pharmacist regularly	411	Decrease in average HbA1c from 8.6% to 8.1% Average cost savings US$ 91.01 per patient	Not identified
Erku et al (2017), Ethiopia^Citation14	RCT	To evaluate the impact of intervention on medication adherence, and hospital admissions in patients with type 2 DM	Drug therapy monitoring, counseling	Medication therapy management to review patient’s medication regimen, customized education, and education on health promoting behaviors, and regular telephone counselling	127	Increase in medication adherence from 9.2% to 61% Decrease in hospital admissions reached 52.1%	Not identified
Choudhry et al (2018), USA^Citation35	RCT	To evaluate the effect of intervention to improve medication adherence	Counseling	Telephone consultation	4078	10% increase in diabetes mellitus outpatient adherence	Imbalance of pharmacist workload with salary received
Sarayani et al (2018), Iran^Citation44	RCT	To evaluate the efficacy of a telephone based intervention to improve clinical outcomes in type 2 DM	Counseling	Consultation by phone calls with trained pharmacist for 3 months	84	Telepharmacy has a significant effect on reducing HbA1c levels and medication adherence scores	Not identified
Cohen et al (2019), USA^Citation29	RCT	To determine the effect of pharmacist-led telehealth for improving diabetes medication adherence	Counseling	Special electronic device (The Health Buddy) and telephone-based consultation	30	Significant improvement in adherence to therapy and HbA1c values	The Health Buddy device requires a landline telephone and a three-prong power plug to operate
Lauffenburger et al (2019), USA^Citation12	RCT	To evaluate the impact of telephone-based intervention on HbA1C for poorly-controlled diabetic patients	Counseling	Telephone consultation and monitoring on medication adherence, lifestyle modifications, and treatment intensification for 12 months	1400	Significant change in HbA1c value, no significant change in medication adherence	Assistance by pharmacists in controlling diet and exercise is inadequate, lifestyle change assistance by pharmacists has not been fully accepted by patients.
Lauffenburger et al (2019), USA^Citation39	RCT	To evaluate whether delivering more intensive insulin-adherence interventions was more effective than delivering a lower-intensity intervention	Counseling	Low intensity: 2 follow-up calls, pillbox, reminder postcard Moderate intensity: 6 follow-up calls, weekly text messaging High intensity: 12 follow-up calls, daily text messages	5596	Significant blood sugar control in the high intensity intervention group	The group that received moderate intensity had more emergency visits and hospitalization than the low intensity group
Peasah et al (2019), USA^Citation43	Prospective, RCT	To evaluate the effectiveness of student pharmacist led telephone follow up to improve HbA1c	Counseling, Pemantauan Terapi Obat	Weekly phone call fo 12 weeks to monitor medication adherence, side effects and DRP	78	The telepharmacy given had the effect of reducing HbA1c levels by 0.35% in the intervention group	Not identified
McConnell et al (2020), USA^Citation36	RCT	To test the impact of connecting physicians and pharmacists to address medication adherence	Counseling	Counseling via telephone to follow up patient medication adherence	2602	No significant improvement in patient medication adherence	The challenge of communication between physicians and pharmacists to be able to provide the right information to address adherence issues
Arain et al (2021), USA^Citation15	RCT	To examine the effectiveness of an in-home electronic medication dispensing system (MDS) on improving medication adherence and health perception	Dispensing	Use of non-surgical devices in the form of pre-packaged medication administration on time with medication administration reminders.	50	Drug delivery technology can improve medication adherence in adults	The risk of MDS not functioning properly, the user does not clearly understand the function of the device
Tourkmani et al (2021), Saudi Arabia^Citation10	Prospective single cohort pre/post intervention	To assess the impact of virtual clinics on glycaemic control among patients with type 2 DM	Counseling	Medication counseling and therapeutic interventions using virtual clinic by telephone	Not mentioned	Significant decrease in HbA1c values from 9.98 ± 1.33 pre intervention to 8.32 ± 1.31 post intervention, decreased patient visits to the hospital in 64% of the patients.	There is no specific platform that guarantees patient privacy There is no classification of patients based on condition status Collaboration and coordination with health facilities should be through written workflows
Khan et al (2022), Saudi Arabia^Citation38	RCT	To evaluate the impact of pharmacist-based diabetic intervention on disease knowledge, medication adherence and self-care management	Counseling	Counseling and monitoring via telepharmacy services (calls, messages or emails) for 6 months	109	Significant improvement in the intervention group towards knowledge of diabetes, and self-care management. Improvements in medication adherence and HbA1c values in the intervention and control groups	Not identified

Abbreviation: RCT, randomized controlled trial.

Jarab AS, Alqudah SG, Mukattash TL, Shattat G, Al-Qirim T. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. J Manag Care Pharm. 2012;18(7):516–526. doi:10.18553/jmcp.2012.18.7.516

 PubMed Web of Science ®Google Scholar

Mcfarland M, Davis K, Wallace J, et al. Use of home telehealth monitoring with active medication therapy management by clinical pharmacists in veterans with poorly controlled type 2 diabetes mellitus. Pharmacotherapy. 2012;32(5):420–426. doi:10.1002/j.1875-9114.2011.01038.x

 PubMed Web of Science ®Google Scholar

Odegard PS, Christensen DB. MAP study: RCT of a medication adherence program for patients with type 2 diabetes. J Am Pharm Assoc. 2012;52(6):753–762. doi:10.1331/JAPhA.2012.11001

 Google Scholar

O’Connor PJ, Schmittdiel JA, Pathak RD, et al. Randomized trial of telephone outreach to improve medication adherence and metabolic control in adults with diabetes. Diabetes Care. 2014;37(12):3317–3324. doi:10.2337/dc14-0596

 PubMed Web of Science ®Google Scholar

Olesen C, Harbig P, Buus KM, Barat I, Damsgaard EM. Impact of pharmaceutical care on adherence, hospitalisations and mortality in elderly patients. Int J Clin Pharm. 2014;36(1):163–171. doi:10.1007/s11096-013-9898-1

 PubMed Web of Science ®Google Scholar

Chen JH, Ou HT, Lin TC, Lai ECC, Yang Kao YH. Pharmaceutical care of elderly patients with poorly controlled type 2 diabetes mellitus: a randomized controlled trial. Int J Clin Pharm. 2016;38(1):88–95. doi:10.1007/s11096-015-0210-4

 PubMed Web of Science ®Google Scholar

Shane-McWhorter L, McAdam-Marx C, Lenert L, et al. Pharmacist-provided diabetes management and education via a telemonitoring program. J Am Pharm Assoc. 2015;55(5):516–526. doi:10.1331/JAPhA.2015.14285

 Google Scholar

Jahangard-Rafsanjani Z, Sarayani A, Nosrati M, et al. Effect of a community pharmacist–delivered diabetes support program for patients receiving specialty medical care: a randomized controlled trial. Diabetes Educ. 2015;41(1):127–135. doi:10.1177/0145721714559132

 PubMed Web of Science ®Google Scholar

Aguiar PM, da Silva CHP, Chiann C, Dórea EL, Lyra DP, Storpirtis S. Pharmacist–physician collaborative care model for patients with uncontrolled type 2 diabetes in Brazil: results from a randomized controlled trial. J Eval Clin Pract. 2018;24(1):22–30. doi:10.1111/jep.12606

 PubMed Web of Science ®Google Scholar

Lee JY, Wong CP, Tan CSS, Nasir NH, Lee SWH. Telemonitoring in fasting individuals with type 2 diabetes mellitus during ramadan: a prospective, randomised controlled study. Sci Rep. 2017;7(1). doi:10.1038/s41598-017-10564-y

 Google Scholar

Lyons I, Barber N, Raynor DK, Wei L. The Medicines Advice Service Evaluation (MASE): a randomised controlled trial of a pharmacist-led telephone based intervention designed to improve medication adherence. BMJ Qual Saf. 2016;25(10):759–769. doi:10.1136/bmjqs-2015-004670

 PubMed Web of Science ®Google Scholar

Siaw MYL, Ko Y, Malone DC, et al. Impact of pharmacist-involved collaborative care on the clinical, humanistic and cost outcomes of high-risk patients with type 2 diabetes (IMPACT): a randomized controlled trial. J Clin Pharm Ther. 2017;42(4):475–482. doi:10.1111/jcpt.12536

 PubMed Web of Science ®Google Scholar

Erku DA, Ayele AA, Mekuria AB, Belachew SA, Hailemeskel B, Tegegn HG. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study. Pharm Pract. 2017;15(3):1–7. doi:10.18549/PharmPract.2017.03.1026

 Google Scholar

Choudhry NK, Isaac T, Lauffenburger JC, et al. Effect of a remotely delivered tailored multicomponent approach to enhance medication taking for patients with hyperlipidemia, hypertension, and diabetes the STIC2IT cluster randomized clinical trial. JAMA Intern Med. 2018;178(9):1182. doi:10.1001/jamainternmed.2018.3189

 PubMed Web of Science ®Google Scholar

Sarayani A, Mashayekhi M, Nosrati M, et al. Efficacy of a telephone-based intervention among patients with type-2 diabetes; a randomized controlled trial in pharmacy practice. Int J Clin Pharm. 2018;40(2):345–353. doi:10.1007/s11096-018-0593-0

 PubMed Web of Science ®Google Scholar

Cohen LB, Taveira TH, Wu WC, Pirraglia PA. Pharmacist-led telehealth disease management program for patients with diabetes and depression. J Telemed Telecare. 2020;26(5). doi:10.1177/1357633X18822575

 PubMed Web of Science ®Google Scholar

Lauffenburger JC, Ghazinouri R, Jan S, et al. Impact of a novel pharmacist-delivered behavioral intervention for patients with poorly-controlled diabetes: the ENhancing outcomes through Goal Assessment and Generating Engagement in Diabetes Mellitus (ENGAGE-DM) pragmatic randomized trial. PLoS One. 2019;14(4):4. doi:10.1371/journal.pone.0214754

 Web of Science ®Google Scholar

Lauffenburger JC, Lewey J, Jan S, et al. Effectiveness of targeted insulin-adherence interventions for glycemic control using predictive analytics among patients with type 2 diabetes: a randomized clinical trial. JAMA Netw open. 2019;2(3):e190657. doi:10.1001/jamanetworkopen.2019.0657

 PubMed Web of Science ®Google Scholar

Peasah SK, Granitz K, Vu M, Jacob B. Effectiveness of a student pharmacist–led telephone follow-up intervention to improve hemoglobin A1C in diabetic patients. J Pharm Pract. 2020;33(6):832–837. doi:10.1177/0897190019857409

 PubMed Web of Science ®Google Scholar

McConnell M, Rogers W, Simeonova E, Wilson IB. Architecting process of care: a randomized controlled study evaluating the impact of providing nonadherence information and pharmacist assistance to physicians. Health Serv Res. 2020;55(1):136–145. doi:10.1111/1475-6773.13243

 PubMed Web of Science ®Google Scholar

Arain MA, Ahmad A, Chiu V, Kembel L. Medication adherence support of an in-home electronic medication dispensing system for individuals living with chronic conditions: a pilot randomized controlled trial. BMC Geriatr. 2021;21(1):1–16. doi:10.1186/s12877-020-01979-w

 PubMed Web of Science ®Google Scholar

M Tourkmani A, J ALHarbi T, Rsheed AMB, et al. The impact of telemedicine on patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia: findings and implications. J Telemed Telecare. 2021. doi:10.1177/1357633X20985763

 PubMed Web of Science ®Google Scholar

Khan YH, Alzarea AI, Alotaibi NH, et al. Evaluation of impact of a pharmacist-led educational campaign on disease knowledge, practices and medication adherence for type-2 diabetic patients: a prospective pre- and post-analysis. Int J Environ Res Public Health. 2022;19(16):10060. doi:10.3390/ijerph191610060

 PubMed Web of Science ®Google Scholar