Implementing a collaborative prescribing, pharmacist-nurse-led adult diabetes clinic within the Robina Health Precinct: A pilot study.

A single-centre, pilot, randomised controlled trial (RCT) comparing a collaborative prescribing pharmacist-nurse-led clinic (intervention) to an endocrinologist-led clinic (usual care). Patients referred to a community based, diabetes multidisciplinary clinic will be randomised to the intervention or control arm. Intervention arm: participants randomised to the intervention arm will see the pharmacist and clinical nurse (CN) in addition to other members of the mutlidisciplinary team (MDT) as per clinical need. Other members of the MDT may include a dietitian, exercise physiologist, podiatrist, physiotherapist, psychologist, occupational therapist, social worker. Consultations will occur face to face for the baseline consultation. Ongoing follow ups with the patient will occur based on clinical need however, at a minimum, follow up will occur at 3 months. Follow up may be either face to face, phone or videoconference with the anticipated follow up appointment time taking approximately 15 – 30 minutes. The final follow up at 6-months will occur face to face and will take 30 minutes. The baseline consult will take 40 - 60 minutes with the pharmacist undertaking: (i) medication history (ii) review of relevant pathology, (iii) observations (e.g., blood pressure [BP], blood glucose level [BGL]), (iv) assessment focusing on diabetes (DM) management and health beliefs, (v) medication adherence assessment and medication review/non-pharmacological management strategies. The CN will contribute jointly to the discussion, providing education specific to diabetes management. A collaborative patient care plan will be developed for discussion with the endocrinologist via videoconference after the consultation and will include recommendations such as prescribing new/modifying/ceasing therapy, ordering further tests, and referring to members of the MDT. The endocrinologist will indicate which recommendations they agree with or do not accept. The pharmacist and CN will enact agreed recommendations, with any prescriptions provided by the endocrinologist and forwarded to the patient. Community pharmacies and general practitioners (GPs) will be included in correspondence to ensure continuity of care. As this is a feasibility study, one of the primary outcomes seeks to measure adherence to the intervention which will be measured by recording session attendance by participants at all scheduled appointments/follow ups.