Development of a Pharmaceutical Care Model to Screen for Metformin-Associated Lactic Acidosis Risk in Diabetic Patients via Telepharmacy at Primary Health Center.

Abstract

      This action research aimed to (1) investigate the current situation and challenges in screening patients with diabetes who are at risk of metformin-associated lactic acidosis (MALA); (2) develop a pharmaceutical care model for patient screening through a telepharmacy system; and (3) evaluate the outcomes of the developed model in terms of screening effectiveness, resolution of drug-related problems, and satisfaction among both patients and healthcare providers. Purposive sampling was used to recruit patients with diabetes aged ≥35 years who received metformin at a dosage of at least 1,000 mg/day and had an estimated glomerular filtration rate (eGFR) of 30–59 mL/min/1.73 m². The study was conducted at Du Nuea Subdistrict Health Promoting Hospital, KosumPhisai District, MahaSarakham Province, Thailand, between March 2025 and February 2026. The intervention incorporated patient monitoring and pharmaceutical consultation through telepharmacy services. Research instruments included a MALA risk screening form, clinical data collection forms, and satisfaction questionnaires. Data were analyzed using descriptive and comparative statistics. The pharmaceutical care model was developed through two PAOR (Planning–Action–Observation–Reflection) cycles.

      Results: Following implementation of the developed model, no cases of MALA were identified, whereas MALA cases had occurred prior to the intervention. Most participants were classified as having a moderate risk of MALA (65.22%). Drug-related problems were still identified; therefore, the screening tool was refined during the second PAOR cycle by incorporating a medication-related problem follow-up component. All identified drug-related problems were successfully resolved (100%). Patients reported the highest level of satisfaction regarding confidence in correct medication use after receiving pharmaceutical counseling (mean = 4.00 ± 0.674). Healthcare providers expressed the greatest satisfaction with the outcomes of the developed pharmaceutical care model (mean = 4.17 ± 0.98).