Imran Hameed Khaliq2*, Hafiz Zahid Mahmood1, Shiza Khaqan3, Yaseen Abdullah2, Nadia Rasheed2, Shakila Zaman2
|a||Independent Researcher, Jeddah, Saudi Arabia|
|b||Gosha-e-Shifa Medical Center, Lahore, Pakistan|
|c||Beaumont Lodge Transitional Care Unit, Dublin, Ireland Beaumont Lodge Transitional Care Unit, Dublin, Ireland|
Published: 21 November 2022
Background & Objectives: Globally, Pakistan is among the top 10 countries in terms of the proportion of the population living with diabetes. Type 2 diabetes cannot be cured permanently, but complications and premature deaths can be prevented by adopting healthy lifestyles. Self-management is the key to controlling diabetes. Besides rational therapeutic approaches, patient counseling by physicians and pharmacists is crucial because self-management practices are generally influenced by the patient’s knowledge of their disease. The objectives of this study were to explore self-management practices among type 2 diabetes patients visiting physicians and pharmacists, and to assess the differences in the self-management practices of patients who visit physicians and those who visit pharmacists concerning type 2 diabetes in the past two years.
Methods: This exploratory study recruited 363 established type 2 diabetes patients using a simple random sampling technique. The patients had consulted either a physician or pharmacist (but not both) over the past two years in relation to their type 2 diabetes, and physically visited a branch of a private-chain retail pharmacy in Lahore, Pakistan. Face-to-face interviews and structured questionnaires with a few open-ended questions were adopted as methods of data collection, focusing on socio-demographic and clinical factors, and the standard self-management practices of patients.
Results: Data were analyzed using frequencies, percentages, means and standard deviations. The difference between categorical variables, i.e. self-management practices and visits to healthcare professionals, were determined using chi-square tests. The results showed that none of the standard diabetes self-management practices were fully adhered to by the patients.
Conclusions: The use of the HbA1C test to monitor diabetes was the least used test among diabetic patients visiting a physician (29.60%) or pharmacist (25.70%). Patients visiting pharmacists adhered to medication use (88.50%, p<0.001), eating a well-balanced diet (75.22%, p=0.050), blood glucose level check (88.50%, p<0.001) and regular blood pressure monitoring (81.42%, p<0.001), whereas patients visiting physicians adhered better to daily feet checking (69.20%, p<0.001) and regular exercise (74.80%, p<0.001). Our study indicates that there is a significant fluctuation in adherence to key self-management practices among type 2 diabetes patients who visit physicians and those who visit pharmacists. Increasing the numbers of pharmacists in the healthcare system who have a special focus on diabetes may improve self-management practices among diabetic patients.
Study design and setting: This exploratory study was conducted between January and March 2018 at three branches of a private-chain retail pharmacy in Lahore, Pakistan. The branches were selected on the basis that they: (i) had a designated pharmacist available for patient counseling; (ii) were located within a one-kilometer radius of public tertiary care hospitals serving the majority of the population belonging to different socio-economic strata.
Sample size and sampling technique: The minimum sample size needed to maintain a 5% margin of error and a 95% confidence interval was calculated as 382 using the Raosoft sample size calculator (16). A sample of 363 patients was selected for this study by employing a simple random sampling technique using a random number table.
Participant recruitment: One pharmacist and one researcher reviewed the prescriptions of walk-in customers and identified potential study participants who presented with type 2 diabetes prescriptions. Patients were eligible only if they were 18 years of age or older with at least a two-year history of type 2 diabetes; they visited the pharmacy in person; and had consulted a healthcare professional – either a physician or a pharmacist (but not both) – over the past two years in relation to type 2 diabetes. Those patients who did not provide written informed consent and those who could not understand the locally spoken languages were excluded from the study. The patients were asked to respond to their pattern of self-management practices for the past two years at the time of the survey. This maximum time duration of two years was chosen because it was recent enough for diabetic patients to recall their self-management practices in detail (8,17).
Questionnaire development: The authors developed a structured questionnaire, with a few open-ended questions, based on relevant literature and reliable and validated scales (10,18-21). The questionnaire was further validated by asking two private endocrinology consultants in Lahore to provide their expert opinions on the content of the study questionnaire in terms of its importance, relativity and simplicity. Also, the questionnaire was pretested with 10 participants to assess acceptability and ease of understanding of the questions.
Data collection: A separate booth was established in each retail pharmacy with a sitting capacity of at least two people. The researcher conducted face-to-face interviews, each typically lasting between 10 and 15 minutes. The study questionnaire was in two parts:
Demographic and clinical profile: Seven questions were included in this section that assessed patients’ demographic information and clinical characteristics. Patients were asked to describe their gender, age (in years), education (in years), average monthly household income in Pakistani rupees (PKR), marital status, history of type 2 diabetes (in years) and family history of diabetes.
Self-management practices: Ten survey items explored the patterns of patients’ self-management practices, i.e. practices undertaken by patients to effectively manage the disease on their own after consulting healthcare professionals. Information was collected as nominal variables (no or yes) for ‘cigarette smoking’, ‘daily feet checking’, ‘daily medication use’, ‘exercising at least 20–30 minutes per day for at least five days per week’, ‘eating a well-balanced, planned diet’, ‘checking random blood glucose level at least once every three months’, ‘checking blood sugar at home, as per health practitioners’ recommendations’, ‘checking HbA1C levels every three months’, ‘use of stress management techniques’ and ‘checking regular random blood pressure monitoring’.
Statistical analysis: Data were analyzed using Statistical Package for Social Sciences software (SPSS version 26.0, SPSS Inc., Chicago, IL, USA). Frequencies, percentages, means and standard deviations were the primary analytical methods used for the data. A chi-square analysis was rendered to determine the difference between the self-management practices of patients who visited physicians and those who visited pharmacists concerning type 2 diabetes.