Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: A multi-center randomized controlled trial

Abstract

Objectives: The effectiveness and costs associated with addition of pharmacist-led group medical visits to standard care for patients with Type-2 Diabetes Mellitus (T2DM) is unknown.

Methods: Randomized-controlled-trial in three US Veteran Health Administration (VHA) Hospitals, where 250 patients with T2DM, HbA1c >7% and either hypertension, active smoking or hyperlipidemia were randomized to either (1) addition of pharmacist-led group-medical-visits or (2) standard care alone for 13 months. Group (4-6 patients) visits consisted of 2-hour, education and comprehensive medication management sessions once weekly for 4 weeks, followed by quarterly visits. Change from baseline in cardiovascular risk estimated by the UKPDS-risk-score, health-related quality-of-life (SF36v) and institutional healthcare costs were compared between study arms.

Results: After 13 months, both groups had similar and significant improvements from baseline in UKPDS-risk-score (-0.02 ±0.09 and -0.04 ±0.09, group visit and standard care respectively, adjusted p<0.05 for both); however, there was no significant difference between the study arms (adjusted p = 0.45). There were no significant differences on improvement from baseline in A1c, systolic-blood-pressure, and LDL as well as health-related quality-of-life measures between the study arms. Compared to 13 months prior, the increase in per-person outpatient expenditure from baseline was significantly lower in the group visit versus the standard care arm, both during the study intervention period and at 13-months after study interventions. The overall VHA healthcare costs/person were comparable between the study arms during the study period (p = 0.15); then decreased by 6% for the group visit but increased by 13% for the standard care arm 13 months post-study (p<0.01).

Conclusions: Addition of pharmacist-led group medical visits in T2DM achieved similar improvements from baseline in cardiovascular risk factors than usual care, but with reduction in the healthcare costs in the group visit arm 13 months after completion compared to the steady rise in cost for the usual care arm.

Trial registration: NCT00554671 ClinicalTrials.gov.

Fig 1. Consort diagram showing the enrollment, randomization and follow-up of study participants.

Fig 2. Change in hemoglobin A1c, blood pressure and lipids during the study period.

There were no significant differences on improvement from baseline in A1c, systolic-blood-pressure, and LDL between group visits and standard care.

Fig 3. Comparison of change in the components of SF-36v over time between pharmacist-led group visits and standard care.

Change from baseline in health status was not significantly different between participants in the group visits or the standard care arms.

Fig 4. Change in healthcare costs during and after the study period between pharmacist-led group visits and standard care.

When compared to baseline, the change in VHA healthcare costs was similar between the study arms during the 13 months of study interventions. Comparison of change in VHA healthcare costs 13 months after the intervention period versus 13 months of the intervention period, significant reductions in the overall VHA health service costs were found for the group visit arm whereas a steady rise in cost was found for the standard care arm.