Impact of a pharmacist-led diabetes management on outcomes, utilization, and cost

Abstract

PurposePharmacist-led medication therapy disease management (MTDM) has shown improvement in clinical outcomes in patients with certain chronic diseases. However, only limited data demonstrating the impact on health care utilization and cost of care are available. This study seeks to evaluate the impact of a pharmacist-led MTDM program on clinical surrogate outcomes, care utilization, and cost of care among patients with diabetes mellitus.MethodsA retrospective cohort study was conducted by utilizing electronic health records and insurance claims data. Patients were identified between February 2011 and December 2014. Data were collected from Geisinger, a large integrated health care system located in Pennsylvania and southern New Jersey. A total of 5,500 patients with diabetes mellitus were identified; 2,750 were enrolled in MTDM and were 1-to-1 propensity score-matched to a comparison cohort not enrolled in a pharmacist-led MTDM program.ResultsThere were no differences between groups in composite HbA1c, blood pressure, or low-density lipoprotein cholesterol goal attainment at 12 months (12% vs 12%, P=0.53). HbA1c goal was reached more frequently among patients without MTDM compared to those at 12 months (57% vs 51%, P<0.0001). There were no significant differences between the two cohorts in the attainment of blood pressure or low-density lipoprotein cholesterol goals at 12 months. MTDM was associated with reduced all-cause hospitalization rate (−19.6%; P=0.02) as well as increased primary care physician visits (18.5%; P<0.001) and lower average per-member-per-month medical cost (−13%, P=0.027).ConclusionDespite the lack of impact on the clinical surrogate outcomes, MTDM was associated with lower cost of care and fewer hospitalizations, possibly facilitated by increased monitoring (ie, higher primary care utilization).

Trajectories of glycemic control with clinical pharmacy specialist management of veterans with type 2 diabetes

“…Diabetes is an important public health problem and the use of clinical pharmacists in diabetes management has shown to improve attainment of goal HbA1c. [1][2][21][22][23][24][25][26] In addition to the final HbA1c attained at a single time point, recent research has shown that the trajectory of how that HbA1c is attained over time is also likely important for outcomes such as mortality, microvascular complications, and even cognitive function. [16][17][18][19][20] While likely helpful in the management of T2DM, clinical pharmacy specialists trained in diabetes management are likely a scarce resource as compared to the total number of patients with T2DM.…”

“…24 Finally, a study by Maeng et al demonstrated a reduction in all-cause hospitalization rate (-19.2%, p = 0.02), lower medical costs (-13%, p=0.027), more primary care provider visits (18.5%, p < 0.001), and a greater proportion of patients attaining goal HbA1c (57% vs. 51%, p < 0.0001) compared to a cohort not enrolled in pharmacist diabetes management. 25 Finally, a recent nationwide retrospective cohort study of the effectiveness of VA CPSs in managing uncontrolled diabetes in 53 VA medical centers with over 12,000 patients and propensity-score matched controls showed that CPS providers managed diabetes as well as primary care providers. 26 While clinical pharmacist management of diabetes can likely assist with goal attainment, due to a limited number of available trained pharmacy specialists, from a practical perspective it is difficult to ascertain which patients are likely to benefit from pharmacist management versus not.…”

Implementation and evaluation of comprehensive medication management in telehealth practices

“…Table 1 provides def-initions and examples of how these indicators have been measured for CMM practices. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] A comprehensive list of implementation frameworks together with the resources to support their use can be found at the Dissemination and Implementation Models website: https:// dissemination-implementation.org/. 33 The Active Implementation Framework (AIF) has formally been applied to CMM in primary care practices.…”

“…Few validated frameworks have been applied to CMM practices. Table provides definitions and examples of how these indicators have been measured for CMM practices . A comprehensive list of implementation frameworks together with the resources to support their use can be found at the Dissemination and Implementation Models website: https://dissemination-implementation.org/…”

Diabetes, Therapeutic Inertia, and Patients’ Medication Experience

“…Studies have repeatedly demonstrated that integrating pharmacists with a collaborative practice agreement into patients' interprofessional care team to provide comprehensive medication management can help overcome therapeutic inertia by assisting patients in achieving their individualized A1C, blood pressure, and LDL cholesterol goals in less time and for a lower overall cost of care compared with care teams without integrated pharmacists (49)(50)(51)(52)(53)(54)(55). Pharmacists can also assist the care team by providing patient and provider education, refill reminders, unit-of-use packaging for prescriptions, and coordination of refills (56).…”