Using Computer Adaptive Assessment Tool to Evaluate High Cost Anti-Diabetic Drug Utilization in the Medical Insurance for Government Employees in Thailand

Diabetes knowledge was generally limited. While most participants reported being adherent to pharmacotherapy, some unintentional dosing errors were reported. Self-monitoring of blood glucose monitoring (SMBG) was common; however, the results were not used in any meaningful way. Most undertook regular physical activity, however, adherence to diet varied and was cultural influenced. Cultural enablers included attitudes towards financial independence and social integration. Lack of linguistic support was perceived as a barrier. Nurturers included family and community support. Participants expressed interest in accessing more support from their community pharmacy. Conclusions: Maltese patients experience barriers to care, such as poor health literacy and limited access to diabetes education, many of which are unrecognised. Culturally they are strongly influenced by social norms and this may impact on adherence to dietary control and other self-management behaviours. There are opportunities for pharmacists to fill in gaps in knowledge and there appears to be some level of interest in such support. Pharmacists must develop cultural competence and take initiatives to deliver diabetes care services that will meet the needs of these groups of patients.