Impact of Pharmacist Educational Intervention on Costs of Medication for Diabetic Patients in Various Tertiary Care Hospitals in Malaysia: A Randomized Controlled Trial

Background and Objective: A lifestyle-associated disease, Diabetes Mellitus, mandates compliance with established policies by physicians and patients to achieve optimal glycemic control. Collaborative care from healthcare providers and patients is essential for effective management, which slows disease progression, improves quality of life, and reduces medication costs. This study assessed the effectiveness of pharmacist-led education initiatives on clinical outcomes and direct treatment costs for patients who have diabetes in two public hospitals in Malaysia. Methods: Four hundred diabetes patients included in the study that were randomly allocated to two corresponding groups. Another group as the control group, consisting of two hundred patients, received standard treatment, whereas the patients in intervention group, including two hundred patients, received pharmacist-led care via Diabetic Medication Therapy Adherence Clinics (DMTAC) with conventional treatment. Pharmacists provided educational interventions emphasizing dietary adjustments, lifestyle modifications, the significance of physical activity, and appropriate medication storage. Among these, 143 control patients and 156 intervention patients completed the one-year study, which comprised two follow-up visits. Clinical outcomes and treatment expenses were evaluated and the analysis of data was performed utilizing version 24 SPSS. Descriptive statistics were presented as mean ± standard deviation, including normality assessed using the skewness, kurtosis and Kolmogorov-Smirnov test. Two-way ANOVA or Independent t-tests were applied for hypothesis testing when data showed normal distribution. Results: After the research, group receiving intervention had a much higher decrease in HbA1c levels relative to the control group (3.59% versus 2.17%; p < 0.001). The intervention group had considerable decreases in systolic blood pressure (9.29 mmHg) and similarly in diastolic blood pressure (7.58 mmHg; with p < 0.005). Additionally, levels of cholestrol in the intervention group improved significantly (0.13 mmol/L; p < 0.001). Moreover, treatment expenses for the pharmacist-led intervention group shown a substantial reduction (p < 0.001). By the second follow-up, the additional cost per patient since baseline was RM 236.07 in the control group, compared to only RM 47.33 per patient in the intervention group with pharmacist involvement. Conclusion: Pharmacist-led interventions led to a significant improvement in HbA1c levels. While medication expenses increased in both groups from the initial follow-up, the control group exhibited significantly greater increase levels than the intervention group.