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Observational Study
. 2018 Nov 14;18(1):855.
doi: 10.1186/s12913-018-3665-x.

Impact of pharmacy services on initial clinical outcomes and medication adherence among veterans with uncontrolled diabetes

Justin D Gatwood  1 , Marie Chisholm-Burns  2 , Robert Davis  3 , Fridtjof Thomas  3 , Praveen Potukuchi  3   4 , Adriana Hung  5   6 , M Shawn McFarland  6 , Csaba P Kovesdy  3   4
Affiliations
Observational Study

Impact of pharmacy services on initial clinical outcomes and medication adherence among veterans with uncontrolled diabetes

Justin D Gatwood et al. BMC Health Serv Res. .

Abstract

Background: Diabetes remains a growing public health threat but evidence supports the role that pharmacists can play in improving diabetes medication use and outcomes. To improve the quality of care, the Veterans Health Administration has widely adopted care models that integrate clinical pharmacists, but more data are needed to interpret the impact of these services. Our objective was to assess clinical pharmacy services' impact on outcomes and oral antidiabetic medication (OAD) use among veterans with uncontrolled diabetes in the first year of therapy.

Methods: This was a retrospective cohort analysis using the Veterans Affairs (VA) Corporate Data Warehouse to identify the first diagnosis of and initiation of OAD therapy for uncomplicated, uncontrolled diabetes (A1C > 7.0%) during 2002-2014. Receipt of clinical pharmacy services was identified using codes within VA electronic health records, and clinical values were obtained at or near the initial fill date and 365 days later. Use of OADs was assessed by proportion of days covered (PDC) for one year following the first filled prescription. Veterans having received clinical pharmacy services were matched 1:1 to those having not seen a clinical pharmacist in the first year of therapy, and generalized linear models assessed changes and differences in outcomes.

Results: The analysis included 5749 patients in each cohort. On average, patients saw a clinical pharmacist 2.5 times throughout the first year of OAD therapy. Adherence to OAD medications was higher in veterans having seen a pharmacist (84.3% vs. 82.4%, p < 0.0001) and more such patients achieved a PDC of at least 80% (72.2% vs. 68.2%, p < 0.0001). After one year of OAD therapy, mean change in hemoglobin A1C was greater among those receiving pharmacy services (- 1.5% vs. -1.4%, p < 0.0001).

Conclusion: Pharmacist participation in diabetes patients' primary care positively affects the multifaceted needs of patients with this condition and comorbid chronic disease.

Keywords: Adherence; Diabetes; Disease management; Pharmacy services; Veterans.

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Conflict of interest statement

Ethics approval

This study was reviewed and approved by institutional review boards at both the University of Tennessee Health Science Center and the Memphis VA Medical Center.

Consent for publication

Not applicable.

Competing interests

Adriana Hung and Csaba Kovesdy are employees of the Department of Veterans Affairs. Opinions expressed are those of the study authors and do not necessarily reflect the views of the Department of Veterans Affairs. Csaba Kovesdy has received research grants from Abbvie, Bayer, and Janssen, and served as consultant for Bayer. The authors report no relevant conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient Selection
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References

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