Pharmacist management of patients with diabetes mellitus enrolled in a rural free clinic

Abstract

Purpose: The impact of pharmacist management of patients with diabetes mellitus enrolled in a rural free clinic was evaluated.

Methods: Data from 95 patients continuously enrolled in a new pharmacist service were analyzed over 24 months. Patients were at least 18 years old, qualified for free care on the basis of income or insurance status, and had a diagnosis of type 2 diabetes mellitus upon clinic entry. Under a collaborative agreement, pharmacists educated patients on diabetes, counseled patients on lifestyle modifications, assessed appropriateness of drug therapy, and managed drug therapy for diabetes and associated comorbid conditions. Clinical impact was measured by changes from baseline glycosylated hemoglobin (HbA(1c)) levels, blood pressure, and lipid levels over a 24-month period. Using published cost estimates, the economic impact of the clinic was calculated based on expected savings for each patient who had a decrease of ≥1% in HbA(1c) value.

Results: Significant reductions from baseline in HbA1c values (p < 0.0001), systolic blood pressure (p = 0.0011), diastolic blood pressure (p = 0.0015), low-density-lipoprotein cholesterol (p < 0.0001), and triglyceride levels (p = 0.0001) were achieved in clinic patients. Based on an expected savings of $1,118 per patient who had a decrease of >1% in HbA(1c) value (n = 67), the pharmacist service was estimated to provide a savings of $74,906 per year.

Conclusion: Pharmacist management of patients with type 2 diabetes significantly influenced clinical and economic outcomes in an uninsured population living in a rural area with few health care resources.