Development of a pharmaceutical care model for patients with type 2 diabetes mellitus through community participation in Mueang District, Lopburi Province.

Abstract

      This study employed Participatory Action Research (PAR) integrated with a mixed-methods approach. The objectives were to: 1) examine the context and existing problems of pharmaceutical care for patients with type 2 diabetes mellitus; 2)develop a community-participatory pharmaceutical care model; and 3) evaluate the effectiveness of the developed model in Mueang District, Lopburi Province. The study was conducted in three phases. Phase 1 explored the context and existing problems through focus group discussions with 42 stakeholders. Phase 2 involved the development of the model based on the Kemmis and McTaggart framework, which comprises four stages: planning, action, observation, and reflection. Phase 3 evaluated the model among 60 patients with poorly controlled type 2 diabetes mellitus and 42 health network members and related stakeholders. Research instruments included a focus group discussion guide, a participation questionnaire, a medication knowledge questionnaire, a medication practice questionnaire, glycated hemoglobin (HbA1c) results, and the Patient-Reported Outcome Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL). Quantitative data were analyzed using descriptive statistics and paired t-test, while qualitative data were analyzed using content analysis.

      The findings indicated that the study area had strong potential in terms of health network capacity and community social capital. However, several key problems were identified, including patients’ limited medication knowledge and inappropriate medication-use behaviors, insufficient continuity of follow-up care within families and communities, and a lack of systematic integration among network partners. The developed model consisted of four major components: 1) medication education and pharmaceutical literacy enhancement; 2) a continuous medication follow-up system; 3) family and community participation; and 4) proactive community-based follow-up. Following implementation of the model, statistically significant improvements were observed. Health network members and related stakeholders demonstrated significantly higher levels of participation (p < .05). Patients also showed significant improvements in medication knowledge (p < .05) and medication-use practices (p < .05), while HbA1c levels were significantly reduced (p < .05). In addition, PROMPT-QoL scores significantly improved after implementation of the model (p < .05).

      In conclusion, the developed community-participatory pharmaceutical care model for patients with type 2 diabetes mellitus effectively enhanced stakeholder participation, improved medication knowledge and practices, contributed to better glycemic control, and improved patients’ pharmaceutical therapy-related quality of life. This model should therefore be promoted for implementation in primary care and community healthcare settings.