Evaluating glycemic control for patient-aligned care team clinical pharmacy specialists at a large Veterans Affairs medical center

Abstract

Background:Management of diabetes mellitus (DM) remains a challenge in the US, as almost half of patients with diabetes are uncontrolled with a hemoglobin A1c (HbA1c) >7%. Over the last decade there has been increasing evidence supporting the integration of Clinical Pharmacy Specialists (CPSs) to multidisciplinary medical teams which have demonstrated improved glycemic control and better clinical outcomes in the primary care setting.Objectives:The primary objective of this study was to evaluate the change in HbA1c levels in patients with diabetes followed by a CPS. The secondary objectives of this study were to evaluate the percent of patients who reached American Diabetes Association (ADA) goal HbA1c (<7%) by study conclusion and evaluate documentation of hypoglycemic events in progress notes.Methods:A retrospective chart review evaluating glycemic control was conducted on patients with DM managed by a CPS at a large Veterans Affairs Medical Center. Patients with a diagnosis of Type 1 or Type 2 DM with a baseline HbA1c ≥9% and at least three CPS visits over twelve months were included in this study. Patients with cognitive impairment as documented by ICD-9 codes or with less than three CPS visits over twelve months were excluded.Results:A sample of 79 patients was identified. The mean HbA1c declined by 1.5 percentage points (from 10.6%, SD=1.4 to 9.1%, SD=1.5) after one year. No patients reached ADA goal of HbA1c <7% at study conclusion, however 23% of patients reached a less stringent goal of <8%. All CPS progress notes assessed episodes of hypoglycemia and provided education, and no hospitalizations were related to hypoglycemic events.Conclusions:Integration of a CPS into a veteran’s diabetes care was associated with improved outcomes and enhanced hypoglycemic education. Our results advance the existing literature by demonstrating a positive association between CPS intervention and improved glycemic control in a complex veteran population.

Impact of a Pharmacist-Led Diabetes Clinic in a Correctional Setting

“…The improvement of glycemic control of this study was comparable to pharmacist-led diabetes interventions in community settings where the average HbA 1c reduction ranged from 0.18% to 2.1%. 4 -13 The differences between our study and extant literature were that our study included IPs treated with oral antidiabetic medications only regardless of baseline HbA 1c , whereas other studies focused on patients with higher baseline HbA 1c (HbA 1c > 9%) with no restriction on therapy types (insulin or oral antidiabetic therapy). In addition, the transient nature of jail settings could theoretically limit the ability to provide chronic disease care.…”

“…3 Many studies have shown that adding clinical pharmacists or advanced practice pharmacists (APPs) to multidisciplinary medical teams to help manage chronic disease like DM improves patient outcomes and decreases physician workload in the community or outpatient settings. 4 -14 However, there is limited literature about the impact of APPs in correctional settings. 13,14 In an effort to expand and improve DM management in Los Angeles County jails, a pilot pharmacist-led diabetes clinic (PLDC) focusing on managing IPs treated with only oral antidiabetics was implemented.…”

Clinical pharmacists in chronic care

“…Diabetic patients who received care from the collaborative team, including a clinical pharmacist, had improvement in most key indicators of diabetes like HbA1c, in both high-and low-income countries and in both urban and rural areas. [62][63][64][65][66][67][68][69][70][71] Emphasizing medication adherence, particularly for patients with longer duration of diabetes and those with multiple comorbid diseases should be strongly considered in future diabetes management programs implemented to improve glycemic control in patients with type 2 diabetes. 72 A mobile phone text message can serve as a simple and cost-effective option in improving medication adherence and clinical outcomes by providing information between clinic visits has been reported.…”

Clinical Pharmacists in Chronic Care [Part 2]

“…Management of DM remains a significant challenge in the US, as estimates indicate that greater than 40% of diabetes patients are uncontrolled with a HbA1c. Diabetic patients who received care from the collaborative team, including a clinical pharmacist, had improvement in most key indicators of diabetes like HbA1c, in both high-and low-income countries and in both urban and rural areas [62][63][64][65][66][67][68][69][70][71]. Emphasizing medication adherence, particularly for patients with longer duration of diabetes and those with multiple comorbid diseases should be strongly considered in future diabetes management programs implemented to improve glycemic control in patients with type 2 diabetes [72].…”