The role of community pharmacy in supporting people with diabetes who have a history of repeated non-attendance at healthcare appointments

Abstract

Diabetes Mellitus is a chronic disease affecting an increasing population of people worldwide. The impact diabetes has on individuals, healthcare systems and economies is not insignificant and there is a wealth of literature demonstrating that if not managed optimally, the condition is associated with significant increased morbidity and premature mortality.

Diabetes management revolves around a number of self-care practices including, but not limited to, life-style changes (eg dietary changes and increasing activity levels), monitoring of blood glucose, taking medications and attendance at retinal eye screening. Regular attendance at diabetes healthcare appointments, such as the annual diabetes review, facilitates the optimisation of diabetes related parameters (eg. glycaemic exposure, blood pressure, cholesterol levels, renal function, weight) and serves as an opportunity to support and empower those living with diabetes. Repeated non-attendance at these healthcare appointments is associated with worse outcomes for an individual and can be deemed as a waste of increasingly stretched health resources.

The aim of this thesis was to explore the role of a hypothetical “community pharmacy diabetes support service (CPDSS)” in supporting those with diabetes who have a history of repeated non-attendance at diabetes healthcare appointments and sub-optimal glycaemic control. It was proposed that community pharmacy may be able to offer an alternative healthcare approach to those identified as being most susceptible to the deleterious effects of diabetes. Primary data collection included a systematic review exploring non-attendance at diabetes healthcare appointments and a literature review on community pharmacy and the role they have had in diabetes care to date. This was followed by two qualitative studies. The fist explored the views and opinions of healthcare professionals, including pharmacists and those involved in the care of those with diabetes towards a hypothetical CPDSS. The second study explored the views of individuals with diabetes for whom the CPDSS would be endeavouring to support.

There were a number of findings in this thesis. Non-attendance at diabetes healthcare appointments was found to typically stem from factors relating to three themes: patient-healthcare professional relationship factors, service-related factors and logistical barriers. Community pharmacy interventions to date have shown promise and community pharmacy have an appetite to offer more to those with diabetes. Furthermore, policy is moving in favour of community pharmacy offering more clinical services. Nonetheless, significant barriers include being under-funded, the underappreciation of pharmacists’ skill-set, both by the public and other healthcare professionals, and their limited digital integration with other healthcare services.

Based on the findings from this thesis, although there is a hypothetical place for community pharmacy in supporting those with diabetes identified as ‘hardly reached,’ at present their role and function may not be best suited to a hypothetical CPDSS intervention until some of the aforementioned barriers have been addressed. Nonetheless, with the changing landscape of the National Health Service and the introduction of Integrated Care Systems, it is likely only a matter of time before some of these limitations are overcome.

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Identifiers

ORCID for Sarah Brewster: orcid.org/0000-0001-8748-9037

ORCID for Richard Holt: orcid.org/0000-0001-8911-6744

ORCID for Katherine Bradbury: orcid.org/0000-0001-5513-7571

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