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Open Access 01-12-2013 | Research article

Can community retail pharmacist and diabetes expert support facilitate insulin initiation by family physicians? Results of the AIM@GP randomized controlled trial

Authors: Stewart B Harris, Hertzel C Gerstein, Jean-François Yale, Lori Berard, John Stewart, Susan Webster-Bogaert, Jordan W Tompkins

Published in: BMC Health Services Research | Issue 1/2013

Abstract

Background

Limited evidence exists on the effectiveness of external diabetes support provided by diabetes specialists and community retail pharmacists to facilitate insulin-prescribing in family practice.

Methods

A stratified, parallel group, randomized control study was conducted in 15 sites across Canada. Family physicians received insulin initiation/titration education, a physician-specific ‘report card’ on the characteristics of their type 2 diabetes (T2DM) population, and a registry of insulin-eligible patients at a workshop. Intervention physicians in addition received: (1) diabetes specialist/educator consultation support (active diabetes specialist/educator consultation support for 2 months [the educator initiated contact every 2 weeks] and passive consultation support for 10 months [family physician initiated as needed]); and (2) community retail pharmacist support (option to refer patients to the pharmacist(s) for a 1-hour insulin-initiation session). The primary outcome was the insulin prescribing rate (IPR) per physician defined as the number of insulin starts of insulin-eligible patients during the 12-month strategy.

Results

Consenting, eligible physicians (n = 151) participated with 15 specialist sites and 107 community pharmacists providing the intervention. Most physicians were male (74%), and had an average of 81 patients with T2DM. Few (9%) routinely initiated patients on insulin. Physicians were randomly allocated to usual care (n = 78) or the intervention (n = 73). Intervention physicians had a mean (SE) IPR of 2.28 (0.27) compared to 2.29 (0.25) for control physicians, with an estimated adjusted RR (95% CI) of 0.99 (0.80 to 1.24), p = 0.96.

Conclusions

An insulin support program utilizing diabetes experts and community retail pharmacists to enhance insulin prescribing in family practice was not successful. Too few physicians are appropriately intensifying diabetes management through insulin initiation, and aggressive therapeutic treatment is lacking.

Trial registration

ClinicalTrial.gov: NCT00593489

Available only for authorised users

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/13/71/prepub

Title: Can community retail pharmacist and diabetes expert support facilitate insulin initiation by family physicians? Results of the AIM@GP randomized controlled trial
Authors: Stewart B Harris
Hertzel C Gerstein
Jean-François Yale
Lori Berard
John Stewart
Susan Webster-Bogaert
Jordan W Tompkins
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/1472-6963-13-71

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Can community retail pharmacist and diabetes expert support facilitate insulin initiation by family physicians? Results of the AIM@GP randomized controlled trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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