Implementation and evaluation of clinical pharmacy services in elderly outpatients with poorly controlled type 2 diabetes: a single-center experience from Vietnam

Elderly patients with type 2 diabetes mellitus (T2DM) often face complex healthcare needs due to comorbidities and polypharmacy, increasing the risk of poor glycemic control and drug-related problems. Comprehensive Clinical Pharmacy Services (CPS) aim to optimize medication management and improve adherence, addressing these challenges effectively. This prospective, single-center implementation study was conducted in the outpatient clinic of the Department of Endocrinology – Diabetes of a tertiary care hospital in Vietnam. Elderly patients aged ≥ 60 years with a diagnosis of T2DM for at least one year and an HbA1c level ≥ 8% were included. A trained clinical pharmacist provided a structured CPS intervention, including Medication Therapy Management (MTM) and collaborative goal-setting. The impact of pharmacy services was assessed through the number of Drug-Related Problems (DRPs) identified and resolved in prescriptions and patient medication use behaviors, improvements in HbA1C levels, as well as the satisfaction of both physicians and patients with the services provided by pharmacists. Among 210 patients (mean age 73.5 years; 71% male), the baseline median HbA1c was 8.6% (IQR: 8.2–9.13), with 90.5% experiencing polypharmacy. A total of 231 DRPs were identified, primarily patient-related (66.2%), including unintentional misuse (28.6%) and intentional non-adherence (14.7%). DRPs related to prescribing included inappropriate drug (21.2%) and dose selection (12.6%). Of 78 pharmacist interventions, 93.5% were fully accepted or partially accepted by physicians; 100.0% were deemed clinically significant (potential Adverse Drug Event Score - pADE ≥ 0.1). Following CPS, 22.9% of patients achieved individualized HbA1c targets (p < 0.05), while the proportion of patients with HbA1c ≥ 8.5% declined from 49.2% to 32.2%. Patient and physician satisfaction with CPS was high (95.2% and 100%, respectively), though only 46.3% of patients expressed willingness to pay for services. Comprehensive CPS has a significant positive impact on quality use of medicine in elderly outpatients with T2DM. These services should be formally integrated into routine diabetes care to optimize outcomes and reduce healthcare utilization in this population.