Development and feasibility study of a community pharmacy intervention to support self-management of patients with type 2 diabetes, in Cyprus
Authors: Pavlidou A , Smith F , Whittlesea C 
Published: November 2023

Abstract

Introduction
The pharmacists’ role has evolved over the past years towards a more clinical role to support patients in managing various prevalent health conditions.1 Cyprus had one of the highest prevalence of diabetes among other European countries in 2021.2 Motivational interviewing has been shown to be an effective tool in consultations.3 In recent years there has been increasing interest in the potential of mobile technologies in health care. However, effective implementation, management, and evaluation of those interventions aiming to improve type 2 diabetes self-management are still being researched.

Aim
The aim of this study was to design and implement a mobile health intervention delivered by a pharmacist applying motivational interviewing techniques, aiming to improve the self-management of type 2 diabetes patients. Then, assess primarily the feasibility and acceptability of the interventions and, secondarily, the participants' medication adherence and self-care activity.

Methods
Type 2 diabetes patients visiting a diabetes clinic in Cyprus were recruited. The intervention included: online communication with the pharmacist, tracking & uploading blood glucose readings, graphical reports, reminders, education, and optimization of pharmacotherapy delivered over an initial face-to-face consultation and up to 3 follow-up telephone appointments at 6-8 weeks intervals. Feasibility was measured by recruitment & retention, use & workability of the intervention, and basic costs. Participants’ & healthcare professionals’ acceptability was assessed via two semi-structured interview schedules based on the Theoretical Framework of Acceptability (Sekhon et al., 2017). Participants’ medication adherence and self-care activity were assessed by Diabetes Self-Care Activities Questionnaire - Greek version before and after the intervention. The study obtained ethical approval from the Cyprus National Bioethics Committee (27/11/2019, reference number EEBK ΕΠ 2019.01.202), the Cyprus Ethics Committee (05/04/2020, reference number 01/20) and the UCL Research Ethics Committee (28/04/2020, reference number Z6364106/2020/04/129).

Results
Twenty-seven patients agreed to participate, of whom 22 completed the intervention. From the available services, all participants agreed to use online communication, chose education, and the review of patients’ medications. A barrier to the intervention was the pharmacist accessing patients’ data, as HbA1c was accessible in 69% of participants and blood glucose in 90%. Based on study findings, participants valued the motivational interview and pharmacist approach, while healthcare professionals highlighted the benefits of pharmacy service, specifically medication adherence. Participants reported improvements in self-care during the study period in three out of five domains assessed in the DSCAQ– Greek version (blood sugar testing, healthy eating, and foot care), whereas adherence to diabetes medications and physical activity remained the same.

Discussion/Conclusion
Although the results were not statistically powered, as this was a feasibility study, there was an indication that this individualised and evidence-based intervention, could holistically support diabetes patients. A limitation of the study was that the person who developed and evaluated the intervention was the same as the person who delivered it. However, the findings indicated the potential value of the intervention to patients and healthcare professionals. It also provided information to support the intervention's integration into the Cyprus healthcare system and in other similar settings.

References
1. Royal Pharmaceutical society (RPS). Improving care for people with long term conditions. [Internet]. London; 2016 [Accessed 09 January 2023]. Available from: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Policy/LTC%20-%20England.pdf.
2. International diabetes federation (IDF). Diabetes atlas 10th edition. [Internet]. Brussels, Belgium; 2021 [Accessed 23 February 2023]. Available from: http://diabetesatlas.org/IDF_Diabetes_Atlas_8e_interactive_EN/.
3. Salimi, C., Momtazi, S., Zenuzian, S. A review on effectiveness of motivational interviewing in the management of diabetes mellitus. JPCPY. 2016; 5(4): 00294. doi: 10.15406/jpcpy.2016.05.00294.