Impact of pharmacist‐led chronic disease management in a Federally Qualified Health Center

Abstract

Introduction There is growing interest in pharmacist‐led chronic disease management (CDM) for underserved populations such as those treated within Federally Qualified Health Centers (FQHCs). Objectives To assess the impact of adding a pharmacist to the healthcare team within an FQHC for CDM. Methods This is a non‐randomized, 6‐month prospective pilot study whereby any member of the healthcare team could refer a patient to receive CDM from a pharmacist. The primary outcome is change in disease control as measured by primary clinical endpoint. Primary clinical endpoints for the most common disease states include glycated hemoglobin (A1C) for type 2 diabetes mellitus (T2DM), systolic blood pressure (SBP) for hypertension, Generalized Anxiety Disorder‐7 (GAD‐7) score for anxiety, and Patient Health Questionnaire‐9 (PHQ‐9) score for depression. Primary clinical endpoints are compared using a paired t test for the modified intention‐to‐treat population. Secondary outcomes include change in self‐reported health and healthcare utilization and difference in satisfaction with care between the primary care provider (PCP) and pharmacist. Results Three hundred patients were enrolled of whom 199 were included. Most patients were referred by their PCP. Statistically significant differences in the mean primary endpoint were observed for all disease states with at least 20 participants, including T2DM (n = 96, change in A1C ‐2.1%, P < 0.001), hypertension (n = 32, change in SBP ‐29.7 mmHg, P < 0.001), anxiety (n = 25, change in GAD‐7 score − 7, P < 0.001), and depression (n = 22, change in PHQ‐9 score −11.1, P < 0.0001). While statistically significant changes in self‐reported healthcare and healthcare utilization were not observed, patients were more satisfied with care. Conclusion When provided with prescriptive authority and working within an interdisciplinary primary care team, pharmacists were able to impact clinical and humanistic outcomes in the FQHC, leading to improved CDM for a variety of illnesses. More studies should be conducted to validate these results in other settings.

Recommendations for wider adoption of clinical pharmacy in Central and Eastern Europe in order to optimise pharmacotherapy and improve patient outcomes

“…However, it is entirely feasible to adapt such work to local systems. There is already an evidence base demonstrating that CPS are beneficial in multiple aspects such as optimized drug utilization and overall hospitalization costs ( McMullin et al, 1999 ; Reardon et al, 2015 ; Rychlickova et al, 2016 ), increased drug safety ( Anderson and Schumock, 2009 ; Simoens et al, 2011 ), improved medication adherence ( Schulz et al, 2019 ; McCarthy and Thomas Bateman, 2022 ), reduced hospital admissions ( Scullin et al, 2007 ; Gillespie et al, 2009 ), reduced length of hospital stay ( Scullin et al, 2007 ), reduced outpatient healthcare utilization and costs ( Byrne and Dalton, 2017 ), higher patient satisfaction ( Yuliandani et al, 2022 ) and positive feedback from other healthcare professionals ( Chevalier et al, 2016 ). Nevertheless, research on the theory and practice of CPS in CEE countries is still of value, as this may help to benchmark available solutions, prioritizing the best ones, and their wider implementation.…”

“…CPS stimulate appropriate prescribing, promote the use of drugs with a higher Medicines Appropriateness Index (MAI) and a lower Medicines Administration Error rate ( Hanlon and Schmader, 2013 ; Scott et al, 2015 ). Pharmacist-led chronic disease management leads to higher patient satisfaction and improves patient adherence ( Schulz et al, 2019 ; McCarthy and Thomas Bateman, 2022 ). Clinical pharmacists educate patients and enhance patient health literacy, which contributes to a reduction of adverse drug reactions (ADRs) ( Spehar et al, 2005 ; Simoens et al, 2011 ).…”

“…Among other things, the Resolution covers aspects of healthcare workforce and education, advocating for strengthening the role of suitably qualified pharmacists for performing pharmaceutical care and clinical pharmacy services ( Committee of Ministers Resolution, 2020 ). Countries where CPS were introduced are currently reaping various benefits, with optimized drug utilization, enhanced drug safety and medication adherence, among the others, leading to better sustainability of their healthcare systems ( Gillespie et al, 2009 ; Hellström et al, 2011 ; Galvin et al, 2013 ; Schulz et al, 2019 ; Lea et al, 2020 ; McCarthy and Thomas Bateman, 2022 ).…”