Implementation and evaluation of a pharmacist-led diabetes care pathway in Alberta community pharmacies (D-PATH)
Type 2 diabetes
Participants in the intervention arm will receive the care using a shared decision-making pharmacist care pathway approach designed to guide type 2 diabetes management to achieve target A1C levels and reduce the risk of diabetes-related complications. The pharmacist care pathway is modelled after the Canadian Diabetes Association Guidelines. This pathway (tool) will be built into a computer web-based program and include step-by-step, algorithm-guided patient assessment to achieve target A1C levels and reduce the risk of diabetes-related complications. This tool will also calculate the participant’s estimated CV risk. The participant and pharmacist will be guided by the care pathway to review the participant’s current type 2 diabetes management and diabetes-related complication risk factors and engage in shared decision-making to guide further management of diabetes. The care pathway will suggest individualized follow-up plans, guideline-driven targets (e.g., A1C or blood pressure or serum lipid concentration targets) and treatments (including lifestyle modifications and medications). The pharmacist and participant will be prompted to reach an agreed diabetes management plan and book a follow-up appointment in 6 weeks’ time. Follow-up appointments will continue every 6 weeks for 6 months. Participants’ treatment regimen may be adapted by initiating new prescriptions medications or adjusting the dosage or frequency of prescription medications or ordering laboratory tests. All the aforementioned activities are within the scope of practice for pharmacists in Alberta (https://www.pharmacists.ca/advocacy/scope-of-practice/). As such, pharmacists can perform them as part of the routine care they are providing to their patients. Control group: The control group will involve facilitated relay of information to participants’ family physician or nurse practitioner. Participants in the control group will have their pharmacist collect information informing the patient’s curr
1. Individuals aged 18 years or older 2. Individuals with type 2 diabetes, further assessed to rule out latent autoimmune diabetes in adults (LADA) or maturity onset diabetes of the young (MODY) by asking patients: “Do you have diabetes that does not require the use of insulin, or did not require the ongoing consistent use of insulin immediately after diagnosis for more than 6 months after diagnosis” AND “Did you develop diabetes as a result of damage to the pancreas such as acute/chronic pancreatitis, or pancreatic surgery?” 3. Individuals with type 2 diabetes not reaching HbA1c target of ≤7.0%
1. Individuals with type 1 diabetes, gestational diabetes, or other forms of diabetes that are not type 2 diabetes 2. Pregnant individuals 3. Individuals at their HbA1c target (HbA1c ≤7.0%) or those with a limited life expectancy, frailty, or lack hypoglycemic awareness (i.e., those with an A1c target >7.0%) 4. Individuals unable to provide consent or who are unwilling to attend follow-up visits