DEVELOPMENT, FEASIBILITY, IMPACT, AND ACCEPTABILITY OF A COMMUNITY PHARMACY-BASED DIABETES CARE PLAN IN LAGOS, NIGERIA

Abstract

Background: Diabetes is a long-term condition and an increasing global health burden, attracting growing interest due to increasing morbidity and resource impact. The traditional view of healthcare professionals as the main decision-makers in disease management has changed, recognising the importance of people managing their own conditions. Community pharmacists are accessible and have key roles in diabetes care. There is evidence of positive outcomes with personalised care for people with diabetes delivered through community pharmacies in high-income countries. However, little such research exists in low-middle-income countries. This programme of work, therefore, aims to develop and feasibility test an evidence-informed community pharmacy-based diabetes care plan intervention in a low-middle income country -Nigeria. Methods: Three stages from the Medical Research Council (MRC) guidance: development, feasibility and pilot evaluation, were adopted in this study. The development phase involved reviews of published evidence. The insights helped inform the components of a diabetes care plan involving person-led goal-setting and motivational interviewing. The draft intervention was reviewed at meetings with three physicians and three co-design workshops with 19 people living with diabetes and 71 pharmacists in Lagos, Nigeria. The final diabetes care plan intervention was implemented, with feasibility and pilot evaluation running concurrently. Patients participated in monthly community pharmacist consultations over six months. Self-reported outcome measures were collected at baseline and study completion. Clinical measurements were collected monthly. Semi-structured interviews were conducted with patients and pharmacists during months 4-6, with patients completing a post-study evaluation questionnaire. Results: Of the recruited pharmacies, 74% (20/27) completed the research, while 86% (89/104) of the enrolled patients had complete data for analysis. Ten pharmacists and 15 patients were interviewed, and 70 patients returned the completed questionnaire. The pilot evaluation demonstrated significant improvements across all outcome measures. The mean patient activation measure (PAM) and quality of life (EQ-VAS) scores improved from 64 to 69 and 76 to 83, respectively, from baseline to study completion. The proportion of patients reporting high adherence improved from 25% to 51% at baseline to study completion. All clinical outcomes significantly improved with BMI, waist circumference, and fasting plasma glucose reductions. Of the questionnaire respondents, 88% were satisfied with the service, and all reported improved diabetes management. Interviewed participants described the care plan as valuable in improving patient confidence in relation to diabetes management. Conclusion: This programme of work was the first mixed-methods evaluation of a diabetes care plan in community pharmacies in Lagos, Nigeria. It demonstrates the importance of a personalised, feasible and acceptable diabetes care plan capable of informing a larger trial. This thesis led to recommendations for policymakers and future personalised diabetes care, including integrating community pharmacy services into extended diabetes care.

Date of Award	1 Aug 2024
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Ellen Schafheutle (Supervisor) & Douglas Steinke (Supervisor)