Optimal Diabetes Care Outcomes Following Face-to-Face Medication Therapy Management Services

Abstract

Pharmacists play an integral role in influencing resolution of drug-related problems. This study examines the relationship between a pharmacist-led and delivered medication therapy management (MTM) program and achievement of Optimal Diabetes Care benchmarks. Data within Fairview Pharmacy Services were used to identify a group of patients with diabetes who received MTM services during a 2007 demonstration project (n=121) and a control group who were invited to receive MTM services but opted out (n=103). Rates of achieving optimal diabetes clinical management for both groups were compared using the D5 diabetes measure for years 2006, 2007, and 2008. The D5 components are: glycosolated hemoglobin (HbA1c<7%); low-density lipoprotein (<100 mg/dl); blood pressure (<130/80 mmHg); tobacco free; and daily aspirin use. Multivariate difference-in-differences (DID) estimation was used to determine the impact of 1 year of MTM services on each care component. Patients who opted in for MTM had higher Charlson scores, more complex medication regimens, and a higher percentage of diabetes with complications (P<0.05). In 2007, the percentage of diabetes patients optimally managed was significantly higher for MTM patients compared to 2006 values (21.49% vs. 45.45%, P<0.01). Nonlinear DID models showed that MTM patients were more likely to meet the HbA1c criterion in 2007 (odds ratio: 2.48, 95% confidence interval [CI]: 1.04-5.85, P=0.038). Linear DID models for HbA1c showed a mean reduction of 0.54% (95% CI: 0.091%-0.98%, P=0.018) for MTM patients. An MTM program contributed to improved optimal diabetes management in a population of patients with complex diabetes clinical profiles.

Clinical Results of a Comprehensive Medication Management Program in a Diabetes Ambulatory Clinic

“…Um outro ensaio clínico controlado realizado em um serviço de endocrinologia de uma unidade de saúde pública brasileira também detectou redução estatisticamente significativa na HbA1c entre os períodos de antes e depois da inserção no serviço de Atenção Farmacêutica e entre o grupo de intervenção e controle 11 . Estudos com o delineamento similar ao do presente estudo (avaliação antes e depois de grupo único) detectaram a redução estatisticamente significativa na HbA1c após provimento de GTM 25,26 . No presente estudo, foi detectada diferença estatisticamente significativa no parâmetro laboratorial de LDLc com uma redução de 17,6% da média inicial.…”

Best Practices: Improving Patient Outcomes and Costs in an ACO Through Comprehensive Medication Therapy Management

“…5,7,8,16,17 Since it began, pharmacists have cared for more than 20,000 patients and resolved more than 107,000 medication-related problems, which, if left unresolved, could lead to hospital readmissions and emergency visits. According to Fairview's 10-year study, about half of the 13,325 patients receiving MTM services from January 1999 through December 2011 had 3 or more drug therapy problems, and one-third had at least 5 problems.…”

“…17 This research compared 121 patients receiving MTM and 103 patients in a control group. The percentage of diabetes patients optimally managed (as measured by a composite of A1c, low-density lipoproteins, blood pressure, aspirin use, and no smoking) was significantly higher for MTM patients (21% vs. 45%).…”

Pharmacy Practice Experiential Programs in the Context of Clinical Education

“…Pharmaceutical care-based services have shown positive clinical, economic and humanistic results, justifying their expansion and consolidation within healthcare systems [5][6][7][8][9][10][11][12][13][14].…”