Differences in the association between structural factors and diabetes self-monitoring support

To determine if the association between the level of community pharmacy diabetes services and six of its reported determinants is influenced by the definition of these services.

Cross-sectional survey among 97% of all Dutch community pharmacies (1,642) registered in 2004. Seven definitions of self-monitoring support (support to patients performing self-monitoring of blood glucose) were constructed: one based on the Dutch pharmacy practice guideline (containing five activities related to patient counselling, calibration and dispensing), one based on patient counselling activities only and five definitions based on each separate activity. Multivariable models of self-monitoring support according to the different definitions were compared.

Associations between determinants and the different definitions of self-monitoring support, expressed as odds ratio (OR) and 95% confidence intervals (95% CI). All definitions were compared to the practice guideline definition.

The ORs of 14 of the 48 possible comparisons of different definitions were significantly different from one. The standardized difference ranged from 1.42 (95% CI: 1.01-1.90) to 3.05 (95% CI: 1.51-4.61). Three out of six predictive models retained different determinants compared to the multivariable model of self-monitoring support based on the guideline.

The association between self-monitoring support and its determinants depend on the definition of self-monitoring support. This underlines the importance for pharmacy practice research to unambiguously describe the characteristics and the setting of an intervention. Only with a complete description of the intervention, the likelihood for success of implementation in another setting can be determined.