| Abstract | Type 2 diabetes mellitus (T2DM) is one of the top ten chronic diseases. It imposes a significant financial and disease burden worldwide. Lack of public awareness and non-adherence to treatment are the main factors contributing to difficulties in managing diabetes. In early 2016, during the documentation of medication histories and assessing medication adherence of the patients attending the surgical pre-assessment clinic at West Middlesex University Hospital (WMUH), it was noticed that most patients and particularly those with diabetes were neither fully aware of their condition nor adherent to their prescribed medication or healthy lifestyle practices. This was particularly pronounced among patients from the Borough of Hounslow, who comprised about 95% of the patients attending the pre-assessment unit. This observation served as the impetus for the development of this project. It aimed to explore and integrate patient-centred care (PCC) and population health management (PHM) approaches to enhance medication adherence and clinical outcomes among diabetic patients, ultimately seeking to improve their overall health outcomes.
The project has two phases. Phase One implemented and assessed the influence of the PCC approach and Phase Two integrated PCC and PHM approaches to introduce lifestyle intervention and improve medication adherence and clinical outcomes for diabetic patients. PCC emphasises personalised, holistic treatment that respects and responds to individual patient preferences, needs and values. It fosters strong patient-provider relationships and shared decision-making, which are critical for effective care. PHM focuses on the health outcomes of groups of individuals, seeking to improve health equity and reduce disparities through data-driven strategies, preventive care, and chronic disease management.
Phase One included conducting a PCC intervention study for 16 weeks involving 40 randomly selected diabetic patients, a survey of 200 T2DM patients and 55 General Practitioners (GPs) in Hounslow treating diabetic patients. It also included conducting an extensive literature review appraising 26 published studies on specific methodological issues of PCC and medication adherence in clinical research. The results of Phase One led to the development of Phase Two where a novel pharmacist-led PHM clinic was established in the hospital pre-assessment unit linked to the community health service to integrate PHM with PCC approaches.
The results of Phase One demonstrated that in a 16-week PCC intervention study of 40 diabetic patients attending the WMUH diabetic clinic, 15% (3) in the control group and none of the intervention group had a problem taking their diabetic medication (p<0.0001) suggesting that PCC interventions improve medication adherence. The intervention results also showed that a higher percentage (55% vs 20%) of the intervention group compared to the control group maintained a healthy eating plan (p =0.048). It was also observed that (95% vs 45%) of the intervention and control groups undertake regular exercise (p =0.048) and (90% vs 55%) of the intervention group regularly monitored their blood sugar (p = 0.03) suggesting that PCC intervention improves diabetes management. These findings are in line with the results of the review of 26 studies focused on PCC interventions originating from 13 countries that had implemented a PCC approach which contributes significantly to improving medication adherence and clinical outcomes in T2DM patients.
The results of Phase Two intervention in a period of 16 weeks resulted in 20 patients with high BMI (32-38) reducing weight by 2-4 kg, 35 patients with high blood pressure (165/95mm) optimised to below 140/80mm, 5 patients stopping smoking, 45 starting exercising three times a week and 30 diabetic patients reporting improved adherence to their regular medicines.
The integration of PCC and PHM presents a transformative approach to modern healthcare delivery aimed at enhancing individual patient outcomes while addressing broader public health goals. This paper highlights successful case studies and best practices in integrating PCC and PHM, demonstrating improved health outcomes, enhanced patient satisfaction, and optimised resource use. Key components of this integrated model include the use of advanced health information systems, multi-disciplinary health care teams and community engagement to ensure that care delivery is both personalised and population-oriented. Challenges such as data recording, training and service alignment are also discussed, alongside potential solutions. The proposed framework underscores the importance of policy support and collaborative efforts across healthcare sectors.
The integration of PCC and PHM represents a promising paradigm shift in healthcare in managing patients with diabetes and other chronic illnesses. It holds the potential to create a more equitable, efficient, and effective healthcare system that is capable of meeting the diverse needs of patients and populations alike. |
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