Implementation of a pharmacist-led, multidisciplinary diabetes management team

Warrington, Laurie; Ayers, Phil; Baldwin, Anna Marie; Wallace, Virginia; Riche, Krista D.; Saulters, Robert; Waldrop, Oliver Grey; Dyess, Teri; Delashmet, Gordon Bart; Peeples, Samuel; Horsley, William; Harris, William J.; Butler, Kenneth R.

doi:10.2146/ajhp110297

Cited by 26 publications

(22 citation statements)

References 9 publications

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“…Several studies supported the favorable effect of pharmacist-led, multidisciplinary team in managing diabetes in different settings [3,14,15]. Mularski et al in a pre-post observational study published in 2012 evaluated the role of a pharmacist-led glycemic control team in managing hyperglycemia in surgical patients with perioperative dysglycemia (diabetes or stress hyperglycemia).…”

Section: Discussionmentioning

confidence: 99%

“…In a pre-post, observational study in hospitalized surgical patients with perioperative dysglycemia, the implementation of a glycemic control protocol by a team of trained pharmacists has been associated with a statistically significant improvement in measures of glycemic control as well as with a decrease in the rate of hypoglycemic events in postoperative days [14]. Similarly, in a 3-year prospective survey at a 564-bed medical center in the United States, Warrington et al demonstrated that the development of a pharmacistled, multidisciplinary diabetes management team contributes in achieving glycemic control (serum blood glucose concentrations less than 200 mg/dl) and decrease in the incidence of sternal surgical-site infections in patients undergoing the coronary artery bypass graft (CABG) procedure [15]. According to the American Diabetes Association (ADA) statement, a collaborative team including physicians, nurses, dietitians, pharmacists, and mental health professionals, is necessary to improve medical care of patients with diabetes [2].…”

Section: Introductionmentioning

confidence: 99%

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Glycemic control in the infectious diseases ward; role of clinical pharmacist interventions

Farsaei

Karimzadeh

Elyasi

et al. 2014

J Infect Dev Ctries

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Introduction: Hyperglycemia is one of the most frequent metabolic complications in hospitalized patients. Increased risk of infection following hyperglycemia has been reported in hospitalized patients and infections may also cause insulin resistance which complicates the control of blood glucose level. In this study the impact of the clinical pharmacist interventions on the glycemic control in patients admitted to infectious diseases ward has been evaluated. Methodology: We conducted a prospective, pre-post interventional study among patients with hyperglycemia. The clinical pharmacist-led multidisciplinary team managed the glycemic profile of patients according to an established insulin protocol commonly used in internal wards. Clinical pharmacists reviewed patients' medical charts for proper insulin administration, evaluated nurses' technique for insulin injection and blood glucose measurement, and educated patients about symptoms of hypoglycemia and the importance of adherence to different aspects of their glycemic management. Results: The percentage of controlled random blood sugar increased from 13.8% in the pre-intervention to 22.3% in the post-intervention group (p value < 0.01). On the other hand, the percentage of controlled fasting blood sugars in the post-intervention group was nonsignificantly higher than in the pre-intervention group. Conclusion: Pharmacists and additional health care providers from other departments such as nursing and dietary departments need to be devoted to glycemic control service. Collaborative practice agreement between physicians is necessary to promote this service and help to increase the use of such services in different settings for diabetes control.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Glycemic control in the infectious diseases ward; role of clinical pharmacist interventions

Farsaei

Karimzadeh

Elyasi

et al. 2014

J Infect Dev Ctries

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“…Previous research regarding multidisciplinary teamwork has shown that successful interprofessional teamwork helped to achieve intensive glycemic control in certain patient groups 4. However, interprofessional teamwork in general, not solely within diabetes care, has certain difficulties in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the disease requires the skill and talents of multiple health care providers, and as such, interprofessional teamwork is extremely important for diabetes care 2,3. Successful interprofessional teamwork – in other words, when multiple health workers from different professional backgrounds work together and are able to provide comprehensive services effectively by working with patients, their families, caregivers, and communities – leads to better patient care and safety, and improves health outcomes for patients 4–7. Therefore, it is not an exaggeration to say that the level of success of interprofessional teamwork may determine diabetes care outcomes.…”

Section: Introductionmentioning

confidence: 99%

The difficulties of interprofessional teamwork in diabetes care: a questionnaire survey

Kishimoto¹,

Noda²

2014

JMDH

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BackgroundDiabetes is a multifactorial disease and its nature means that interprofessional teamwork is essential for its treatment. However, in general, interprofessional teamwork has certain problems that impede its function. To clarify these problems in relation to diabetes care, a questionnaire survey was conducted.MethodsThe participants who were involved in diabetes-related educational seminars, and medical personnel who were engaged in diabetes care from the National Center for Global Health and Medicine, were asked to complete the questionnaire about perceptions of, and satisfaction with, interprofessional teamwork across multiple health care providers, who were actually involved in diabetes care.ResultsFrom 456 people who were asked to take the questionnaire, 275 people answered. The percentages of the respondents according to profession who considered multidisciplinary teamwork sufficient were as follows: physicians, 20.5%; nurses, 12.7%; registered dietitians, 29.6%; pharmacists, 21.9%; physiotherapists, 18.2%; and clinical laboratory technicians 15.4%. Insufficient interprofessional communication and inconsistency in motivation levels among staff were frequently cited as causes of insufficient teamwork. All professions considered interprofessional meetings or conferences necessary and essential for teamwork.ConclusionThe survey revealed that interprofessional teamwork in diabetes care is currently insufficient. Continuous efforts to change each profession’s perceptions about interprofessional teamwork and efforts to improve the quality of interprofessional meetings are necessary.

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“…6 Effective administrative support, adequate human and financial resources, and continual planned assessment of performance by stakeholders, are all factors necessary for the planning, development, implementation, and success of a collaborative care model. 60,61 Although collaboration, in general, has been shown to result in cost savings for the health care system through reduction in frequency of hospitalization and more appropriate medication use, in the majority of studies, however, cost effectiveness of the collaborative care model in improving patient outcomes compared to traditional care was not assessed precisely.…”

Section: Challenges and Barriers In Cppmentioning

confidence: 99%

Collaborative pharmacy practice: an update

Law¹,

Gupta²,

Hata³

et al. 2013

IPRP

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Collaborative practice among health professionals is slowly coming of age, given the global focus on efficiency and effectiveness of care to achieve positive patient outcomes and to reduce the economic burden of fragmented care. Collaborative pharmacy practice (CPP) is accordingly evolving within different models including: disease management, medication therapy management, patient centered medical home, and accountable care organizations. Pharmacist roles in these models relate to drug therapy management and include therapy introduction, adjustment, or discontinuation, patient counseling and education, and identification, resolution, and prevention of problems leading to drug interactions and adverse reactions. Most forms of CPP occur with physicians in various settings. Collaborative practice agreements exist in many states in the US and are mentioned in the International Pharmaceutical Federation policy statement. Impetus for CPP comes from health system and economic concerns, as well as from a regulatory push. There are positive examples in community, ambulatory care, and inpatient settings that have well documented protocols, indicators of care, and measurement and reporting of clinical, economic, and patient reported outcomes; however, implementation of the practice is still not widespread. Conceptual and implementation challenges include health professional training, attitudes, confidence and comfort levels, power and communication issues, logistic barriers of time, workload, proximity, resistance to establish and adopt regulations, and importantly, payment models. Some of the attitudinal and perceptual challenges can be mitigated by incorporation of interprofessional concepts and practice in health profession education. Other challenges need to be addressed across health systems, given the inefficiencies and problems that arise from lack of communication and coordination of patient care including medication nonadherence, errors and patient safety, complexity of compounded health problems, and potential liability. The existing evidence needs to be examined to address some challenges and improve infrastructure for CPP.

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Implementation of a pharmacist-led, multidisciplinary diabetes management team

Abstract: Implementation of a pharmacist-led, multidisciplinary DMT helped to achieve intensive glycemic control in CABG patients and decrease the rate of infection.

Cited by 26 publications

References 9 publications

Glycemic control in the infectious diseases ward; role of clinical pharmacist interventions

Glycemic control in the infectious diseases ward; role of clinical pharmacist interventions

The difficulties of interprofessional teamwork in diabetes care: a questionnaire survey

Collaborative pharmacy practice: an update

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