gms | German Medical Science

Background: The Techniker Krankenkasse started a coaching programme for insurants with type 2 diabetes in august 2013. Aim of the programme is to support patients with type 2 diabetes in their medication use, to increase their understanding of the disease and finally to improve medication adherence.

Materials and Methods: Patients were identified for coaching by means of their medication and diagnosis history (via ATC- and ICD-10-Codes). They were eligible if they had not less than two diagnosis of type 2 diabetes (ICD-10: E11) and not less than two prescriptions of oral antidiabetic drugs (OAD, ATC A10B) and were adherent to their medication up to 75% (defined as 25% difference between expected and actual filled prescriptions of OAD DDDs to cover a period of 2 years). Exclusion criteria were use of insulin, malignant or psychological comorbidities and age > 80 years. Coaching took place in five modules (1. introduction to the programme, 2. information on the disease, 3. drugs and adherence, 4. lifestyle, 5. final perspectives) via telephone by especially trained pharmacists, pharmaceutical technicians and nurses. Every module consisted of one call. Calls were generally made every 4 weeks. Drug related problems were mainly assessed in module 2 or 3. Patients who had completed module 2 until 21.09.2014 (cut-off day) were included in first-year-evaluation. Evaluation considered adverse events (AEs) for all eligible patients and medication satisfaction (MS) for patients who had also accomplished module 3 by then. Reporting of AEs and MS was non-standardized. AEs were determined as free text by coaches; MS was measured using a patient reported outcome scale from 1 (low) to 10 (high).

Results: Overall 746 insurants were included in the programme until cut-off day. 46.3% (n=345) of them were eligible for evaluation, 41.3% (n=308) had also finished module 3 and 12.5% (n=93) had already completed the whole coaching. 31.9% (n=110) of the participants were female and 26.1% (n=90) were from North-Rhine-Westphalia.

36.8% (n=127) of the eligible patients reported a total of 129 AEs of their medication. The most common AE was hypoglycemia (36.4%), followed by diarrhea and gastrointestinal symptoms (34.9%). Hypoglycemia was associated with use of sulfonylureas or glinides (53.2%), diarrhea and gastrointestinal symptoms with use of metformin or combinations of metformin and gliptins (89.0%).

Total medication satisfaction was high (mean 8.5 points). Patients rated their medication as important (mean 9.4 points). MS increased for patients, who had already completed the whole coaching, from 8.54 points (mean) at 3rd call to 8.94 points (mean) at the end of the coaching programme. The rated importance of medication increased from 9.35 (mean) at 3rd call to 9.50 points (mean) at the end of the coaching, respectively.

Conclusion: The MedicationCoach can support patients with type 2 diabetics in drug therapy. Coaching might be helpful in dealing with the disease and avoiding AEs. Whether the high MS in contrast to reported AEs is determined by the coaching programme cannot be answered yet and will be part of a separate inquiry.