A drop-in clinic for patients with poorly-controlled diabetes: A community pharmacy feasibility study

Background: Preparatory work suggests that there may be a role for the pharmacist in managing sub-optimal medication adherence and dose titration of prescribed medicines in patients with type 2 diabetes. Patients have reported that they are receptive towards pharmacists becoming involved in their care providing that this is integrated into the care received from their medical practice.

Objective: To determine whether a community pharmacy diabetes drop-in clinic is feasible and acceptable to patients with poorly controlled type 2 diabetes.

Setting: Five community pharmacies in Norfolk, UK.

Method: Poorly controlled patients, as defined by a national General Practitioner incentive scheme, were invited to participate in the study by a letter posted by their medical practice. One four-hour, pharmacist clinic, where participants were able to "drop-in", was conducted in five pharmacies every week for four to six weeks. Questionnaires before and after the consultation were used to determine the clinic's effect on satisfaction with, and beliefs about, medicines and adherence along with participant satisfaction. Pharmacists had the opportunity to provide feedback via "debrief" interviews.

Main outcome measure: As a feasibility study, a combination of outcomes were explored including information satisfaction and adherence.

Results: Thirty-three (9.6%) of the 342 patients with type 2 diabetes posted letters were recruited from four pharmacies. Follow-up questionnaire completion rate was 88%. The clinic demonstrated little change in the parameters measured over three months. All of the participants rated their general impression of the service as good or very good and all would be happy to recommend the service to others with diabetes. Sixteen participants (59%) stated that it would make them more likely to consult their pharmacist in the future. Pharmacists enjoyed providing the service as it allowed them to interact more formally, and for longer, with patients.

Conclusion: This research has demonstrated that a community pharmacy drop-in clinic is feasible and likely to be acceptable to both patients and pharmacists; however, cost effectiveness of such a service should be explored in future studies. Further thought should also be given to how this service can complement that provided by a nurse in the medical practice and how the pharmacist can provide additional benefit to the NHS.