Pharmacist-Managed Diabetes Center Interventions Ensure Quality and Safety in Elderly Patients

Abstract

Objectives: This quality-improvement study aimed to replicate historical Patient Safety Clinical Pharmacy Services Collaborative results in high-risk Medicare beneficiaries with diabetes to achieve reductions in A1C, adverse drug events (ADEs), and potential ADEs (pADEs).

Design: The model included an interdisciplinary team led by a pharmacist located inside a community pharmacy to provide disease state management and medication therapy management (MTM) to the study population.

Setting: Apple Discount Drugs is an independent community pharmacy located in Salisbury, Maryland. The interdisciplinary team included pharmacists, respiratory therapists, durable medical equipment (DME) specialists, and a referring prescriber.

Participants: High-risk Medicare beneficiaries, defined as patients with A1C > 9.0% and/or a documented history of three or more hypoglycemic events in the previous six months (defined by blood glucose < 70 mg/dL, patient-described signs and symptoms of hypoglycemia, or a combination of each). All patients were 65 years of age and older and diagnosed with type 2 diabetes mellitus.

Interventions: Patients received longitudinal diabetes self-management education (DSME) and MTM from pharmacist certified diabetes educators. MTM included a comprehensive medication review performed by a pharmacist.

Main outcome measure: The study looked at the effects of the program's interventions on A1C and ADEs.

Results: The study cohort saw a 90% reduction of patients with an A1C > 9.0% compared with baseline. ADEs were reduced by 49% and pADEs were reduced by 67%.

Conclusions: An integrated, pharmacist-directed DSME and MTM program for high-risk Medicare beneficiaries resulted in improvements in A1C quality measure and mitigated medication associated harm.