Impact of Pharmacist-Led Diabetes Management in Primary Care Clinics

Abstract

Purpose: Current literature supports that pharmacists effectively lower hemoglobin A1c (HbA1c) in diabetic patients. Little data exists on pharmacists’ effects on comorbidity management, patient satisfaction, or financial viability of these positions. This study looked to assess the impact of pharmacists on diabetes management compared to usual care.
 Methods: This multi-site, two-part study includes a retrospective chart review of patients referred to the pharmacist versus usual care within a large academic health system. The pharmacists collaborated under a consult agreement with primary care physicians. The second part of the study assessed patient satisfaction through an abbreviated CG-CAHPS survey.
 Results:A total of 206 patients with diabetes for an average of 12 years were included. The average patient age was 62 years with 60% of patients identifying as female and 81% as African-American. Patients were enrolled in a 2:1 fashion with 138 patients in the intervention group. Average baseline HbA1c was 10.1% in the intervention group and 9.3% in the control group (p= 0.0125). At 6 months, the mean change in HbA1c was -2.17% and 0.48% for the intervention and control groups respectively (p
 Conclusion: Pharmacists are effective at lowering HbA1c in primary care clinics, and patients were highly satisfied with these services. While direct revenue from this service did not meet cost, the pharmacist did positively affect outcomes that contribute to reimbursement.
 Treatment of Human Subjects: IRB review/approval required and obtained
 
 Type: Original Research

Impact of Physician-Pharmacist Collaboration on Diabetes Outcomes and Health Care Use

“…14 Collaborative practice agreements provide pharmacists the ability to manage chronic disease states in collaboration with physicians to improve patient outcomes and patient satisfaction. 5,[14][15][16] The involvement of clinical pharmacists in direct patient care has been shown to improve clinical outcomes in many chronic disease states, including but not limited to diabetes, hypertension, and dyslipidemia. 2,[6][7][8][9]12,13,[16][17][18][19][20] Data also supports that clinical pharmacy services improve provider work-life 21 and reduce health care costs.…”

“…5,[14][15][16] The involvement of clinical pharmacists in direct patient care has been shown to improve clinical outcomes in many chronic disease states, including but not limited to diabetes, hypertension, and dyslipidemia. 2,[6][7][8][9]12,13,[16][17][18][19][20] Data also supports that clinical pharmacy services improve provider work-life 21 and reduce health care costs. 12,13,16,17,22,23 Matzke et al 17 found that the inclusion of clinical pharmacists in a collaborative care model demonstrated significant improvements in glycosylated hemoglobin, blood pressure, low-density lipoprotein (LDL) cholesterol, and total cholesterol in the collaborative care group compared with the usual care group.…”

“…4,15 With the high prevalence of diabetes, along with the complex medication management and the association of high health care costs, there is a substantial amount of literature to support the involvement of clinical pharmacists in diabetes management to improve and meet clinical goals. 2,6,9,[16][17][18][19][23][24][25] Despite the support of published literature showing the effect of clinical pharmacists on improvement of patient outcomes, very few studies compare collaborative pharmacist management to that of physician-only care in a primary care setting. In addition, data for cost evaluation of clinical pharmacy services in a primary care clinic is limited.…”

Impact of an Advanced Practice Pharmacist Type 2 Diabetes Management Program: A Pilot Study

“…26 Furthermore, another study found a large HbA1c reduction in patients who enrolled in the pharmacist-management group compared to usual care. 27 In our study, the APh made independent therapeutic decisions during patient visits. The primary care physicians at the clinic did not change any of the therapeutic decisions made by the APh.…”

“… 26 Furthermore, another study found a large HbA1c reduction in patients who enrolled in the pharmacist-management group compared to usual care. 27 …”