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Department of Pharmacoepidemiology and Pharmacotherapy Utrecht Institute of Pharmaceutical Sciences Scientific Institute of Dutch Pharmacists Utrecht, Netherlands
Department of Pharmacoepidemiology and Pharmacotherapy Utrecht Institute of Pharmaceutical Sciences PO Box 80082, 3508 TB Utrecht, Netherlands fax (0)30 2539166 o.h.klungel{at}pharm.uu.nl
Department of Pharmacoepidemiology and Pharmacotherapy Utrecht Institute of Pharmaceutical Sciences
Department of Pharmacoepidemiology and Pharmacotherapy Utrecht Institute of Pharmaceutical Sciences Scientific Institute of Dutch Pharmacists
Published Online, August 31, 2004. www.theannals.com, DOI 10.1345/aph.1E135
Methods. We used data from the PHARMO-record linkage system, containing all dispensing records of 950 000 residents of 25 population-defined areas in the Netherlands.4 The study population consisted of all incident patients with type 1 and 2 diabetes from 1991 to 2001. Complete dispensing data during that period were extracted. Using a Cox proportional hazard model, we studied the association between the community pharmacy in which the patient was registered and the time to the first test strips dispensed.
Results. Of 8233 incident patients, 19.4% were dispensed test strips at least once. Patient characteristics varied between pharmacies and, to a lesser extent, between regions. After having adjusted for these differences, the patient's community pharmacy was still independently associated with the use of test strips. Furthermore, the variation in dispensing of test strips between pharmacies in one region was considerably less than that between pharmacies in different regions (Figure 1).
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Because diabetic patients visit a pharmacy on average 5–6 times per year, community pharmacists are well placed to educate and support patients performing the complicated process of SMBG. Furthermore, there is evidence that a pharmaceutical care model for diabetes management, including training in SMBG, improves glycosylated hemoglobin and fasting plasma glucose.5
Our findings suggest that the chance of receiving test strips differs between community pharmacies. Moreover, the role of community pharmacy in dispensing of test strips is significantly modified by region. Several reasons for this variability exist, not all under direct control of community pharmacists. Region-specific factors, for example, distribution of test materials by mail order, reimbursement of test strip use, and availability of qualified personnel, may have a major effect on the structure and process of diabetes care activities of individual pharmacies. Other factors, however, are under control of pharmacists, for example, sufficient training or attitudes toward diabetes being a treatable disease. Since the data on pharmacy and region were coded, the relative effect of these factors will have to be studied further.
Because of the observed differences between pharmacies, not all may experience the same barriers in dispensing of test strips. This underscores that implementing practice guidelines for diabetes in community pharmacy may require different approaches. Although our observations only apply to the Dutch situation, it is not unlikely that variability in dispensing of test strips also occurs in other countries. Factors such as reimbursement, qualified personnel, and training are not unique to the Netherlands.
References
This article has been cited by other articles:
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  M. J Storimans, O. H Klungel, H. Talsma, M. L Bouvy, and C. J de Blaey Collaborative Services Among Community Pharmacies for Patients with Diabetes Ann. Pharmacother., October 1, 2005; 39(10): 1647 - 1652. [Abstract] [Full Text] [PDF]
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