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. 2021 Jun 1;59(6):477-486.
doi: 10.1097/MLR.0000000000001521.

Patient Outcomes Associated With Utilization of Education, Case Management, and Advanced Practice Pharmacy Services by American Indian and Alaska Native Peoples With Diabetes

Joan O'Connell  1 , Margaret Reid  2 , Jennifer Rockell  3 , Kathleen Harty  4 , Marcelo Perraillon  2 , Spero Manson  1
Affiliations

Patient Outcomes Associated With Utilization of Education, Case Management, and Advanced Practice Pharmacy Services by American Indian and Alaska Native Peoples With Diabetes

Joan O'Connell et al. Med Care. .

Abstract

Background: The burden of diabetes is exceptionally high among American Indian and Alaska Native (AI/AN) peoples. The Indian Health Service (IHS) and Tribal health programs provide education, case management, and advanced practice pharmacy (ECP) services for AI/ANs with diabetes to improve their health outcomes.

Objective: The objective of this study was to evaluate patient outcomes associated with ECP use by AI/AN adults with diabetes.

Research design: This observational study included the analysis of IHS data for fiscal years (FY) 2011-2013. Using propensity score models, we assessed FY2013 patient outcomes associated with FY2012 ECP use, controlling for FY2011 baseline characteristics.

Subjects: AI/AN adults with diabetes who used IHS and Tribal health services (n=28,578).

Measures: We compared health status and hospital utilization outcomes for ECP users and nonusers.

Results: Among adults with diabetes, ECP users, compared with nonusers, had lower odds of high systolic blood pressure [odds ratio (OR)=0.85, P<0.001] and high low-density lipoprotein cholesterol (OR=0.89, P<0.01). Among adults with diabetes absent cardiovascular disease (CVD) at baseline, 3 or more ECP visits, compared with no visits, was associated with lower odds of CVD onset (OR=0.79, P<0.05). Among adults with diabetes and CVD, any ECP use was associated with lower odds of end-stage renal disease onset (OR=0.60, P<0.05). ECP users had lower odds of 1 or more hospitalizations (OR=0.80, P<0.001).

Conclusions: Findings on positive patient outcomes associated with ECP use by adults with diabetes may inform IHS and Tribal policies, funding, and enhancements to ECP services to reduce disparities between AI/ANs and other populations in diabetes-related morbidity and mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services;2020.
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    1. O’Connell J, Yi R, Wilson C, et al. Racial disparities in health status: A comparison of the morbidity among American Indian and U.S. adults with diabetes. Diabetes Care. 2010;33:1–8. - PMC - PubMed
    1. U.S. Department of Health and Human Services, Indian Health Service. Fact sheet: Special Diabetes Program for Indians (SDPI), Changing the course of diabetes. 2017. Available at: https://www.ihs.gov/sdpi/includes/themes/responsive2017/display_objects/.... Accessed 04/29/2019.

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