Enhancing Diabetes Medication Adherence Clinics Service Delivery: A Pre-Delivery Framework based on the Double Diamond Model
Framework for DMTAC Enhancement
Abstract
Diabetes medication therapy adherence clinics (DMTAC) in Malaysia are crucial for managing type 2 diabetes but encounter significant operational challenges, including high rates of patient non-attendance, program dropout and variability in service delivery, which collectively undermine their effectiveness. Guided by the first three phases of the Double Diamond design-thinking model (discover, define, develop), this study aimed to create an evidence-based pre-delivery framework to systematically address these gaps. Evidence was triangulated from (i) a retrospective cohort study of 198 patients that quantified clinical outcomes and attrition risk factors; (ii) semi-structured interviews with 32 patients that illuminated barriers, facilitators and service preferences; and (iii) a comprehensive scoping review of 61 randomised controlled trials on pharmacist-led diabetes interventions. Design requirements extracted from these sources were mapped to the Transtheoretical Model (TTM), Health Action Process Approach (HAPA) and the communication models of Motivational Interviewing (MI) and Shared Decision-Making (SDM). The resulting framework comprised three sequential domains: (i) Pre-Service: stage-matched assessment of patient readiness and barrier screening; (iii) Within-Service: modular, patient-centred interventions delivered via MI or SDM with explicit action- and coping-planning rooted in HAPA; and (iii) Post-Service: flexible follow-up modalities, tailored self-management aids and automated appointment reminders. This pre-delivery framework offers clinicians and service managers an actionable, theory-informed guide to enhance engagement, medication adherence and clinical outcomes across Malaysian DMTAC settings.
Keywords :
Diabetes management; medication adherence; pharmacist-led intervention,
Abstrak
Klinik kepatuhan terapi ubat-ubatan diabetes (DMTAC) di Malaysia memainkan peranan penting dalam pengurusan penyakit diabetes jenis 2. Namun, ia berdepan dengan beberapa cabaran seperti kadar ketidakhadiran pesakit yang tinggi, keciciran daripada program dan ketidakseragaman dalam penyampaian perkhidmatan, yang secara keseluruhannya menjejaskan keberkesanan klinik ini. Berpandukan tiga fasa pertama model reka bentuk Berlian Berganda (Double Diamond) (penemuan, penerangan, pembangunan), kajian ini bertujuan untuk membangunkan kerangka pra-penyampaian berasaskan bukti untuk menangani jurang tersebut secara sistematik. Bukti disintesis daripada (i) kajian kohort retrospektif melibatkan 198 pesakit yang mengukur hasil klinikal dan faktor risiko keciciran; (ii) temu bual separa berstruktur dengan 32 pesakit yang mengenal pasti halangan, pemudah cara dan keutamaan perkhidmatan; serta (iii) tinjauan skop komprehensif melibatkan 61 ujian terkawal rawak mengenai intervensi diabetes yang dikendalikan ahli farmasi. Keperluan reka bentuk yang diperolehi telah dipadankan dengan Model Transteoretikal (TTM), "Health Action Process Approach" (HAPA), serta model komunikasi "Motivational Interviewing" (MI) dan "Shared Decision-Making" (SDM). Kerangka yang terhasil merangkumi tiga domain: (i) Pra-perkhidmatan: penilaian tahap kesediaan pesakit dan saringan halangan mengikut peringkat perubahan; (ii) Semasa perkhidmatan: intervensi modular berfokuskan pesakit yang disampaikan melalui MI atau SDM dengan perancangan tindakan dan penanganan berpaksikan HAPA; dan (iii) Pasca perkhidmatan: kaedah lawatan susulan yang fleksibel, bantuan pengurusan diri yang disesuaikan, serta peringatan janji temu automatik. Kerangka pra-penyampaian ini menawarkan panduan berasaskan teori yang boleh dilaksanakan oleh pakar klinikal dan pengurus perkhidmatan untuk meningkatkan penglibatan pesakit, kepatuhan ubat dan hasil klinikal di DMTAC seluruh Malaysia.
Kata Kunci :
Intervensi ahli farmasi; kepatuhan ubat; pengurusan diabetes,
Correspondance Address
Ernieda Hatah. Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia. Tel: +603 92897328 Email: ernieda@ukm.edu.my
