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. 2018 Feb;48(1):65-71.
doi: 10.1002/jppr.1349. Epub 2018 Feb 15.

Outcomes of a pharmacist-managed clinic for underserved persons with unmanaged type 2 diabetes mellitus

Ashley L Lefebvre  1 , Andrew R Zullo  1   2 , Ruth Dapaah-Afriyie  1 , Christine M Collins  1 , Khaled A Elsaid  1   3
Affiliations

Outcomes of a pharmacist-managed clinic for underserved persons with unmanaged type 2 diabetes mellitus

Ashley L Lefebvre et al. J Pharm Pract Res. 2018 Feb.

Abstract

Background: A multidisciplinary approach is recommended for the management of type 2 diabetes mellitus (DM).

Aim: To evaluate the impact of a pharmacist intervention on haemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), and diabetes-related hospitalisations in an underserved cohort with unmanaged type 2 DM.

Methods: This analysis was a retrospective cohort study. Criteria for inclusion were persons with unmanaged type 2 DM defined as HbA1c values ≥8% at time of enrolment, ≥18 years old, and enrolment in a pharmacist-managed clinic for ≥12 months. Pre- and post-intervention differences in HbA1c, SBP and DBP values were assessed using repeated measures analysis of variance (ANOVA). The risk of diabetes-related hospitalisations was estimated during the 12 months prior and during the 12 months post-intervention, and the relative risk (RR) was calculated.

Results: Mean HbA1c values at 3, 6 and 12 months post-intervention were lower than baseline values (p < 0.05). There was no significant difference in mean HbA1c values at 6 or 12 months compared to 3 months post intervention. Mean SBP values at 3, 6 and 12 months were lower than baseline (p < 0.05). Likewise, mean DBP values at 6 and 12 months were lower than baseline (p < 0.05). The estimated RR of diabetes-related hospitalisations was 0.40 (95% CI: 0.20-0.83; p = 0.013).

Conclusion: Enrolment in a pharmacist-managed diabetes program was associated with a significant reduction in HbA1c, SBP and DBP and reduction in risk of diabetes-related hospitalisations in an underserved cohort of patients with diabetes over a 12-month period.

Keywords: ambulatory care; diabetes mellitus; indigent care; pharmacist.

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Conflict of interest statement

Conflict of interests statement The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Process flowchart of the multidisciplinary coordinated care model for persons with treatment-resistant/unmanaged type 2 diabetes. eMR = Electronic Medical Record, DM = diabetes mellitus. Certified pharmacists conduct medication therapy management (MTM), disease state education, administer immunisations and recommend preventive care.
Figure 2
Figure 2
(A) Trend of mean haemoglobin A1c (HbA1c) values (± standard deviation) prior to and following enrolment in the pharmacist-managed diabetes clinic (n = 60). *Indicates that mean HbA1c values at 3, 6 and 12 months following enrolment in the pharmacist-run program were significantly lower than baseline values (p < 0.05). (B) Change in haemoglobin A1c (HbA1c) values from previous recorded values following enrolment in the pharmacist-run medical clinic. Data is presented as mean change with 95% confidence intervals (CI). *Indicates that the reduction in HbA1c at 3 months following enrolment is significantly different from 0 (p < 0.05). The change in mean HbA1c values at 6 months from corresponding values at 3 months was not different from 0. Similarly, the change in mean HbA1c values at 12 months from corresponding values at 6 months was not different from 0. (C) Impact of pharmacist-managed diabetes clinic on systolic blood pressure (SBP) and diastolic blood pressure (DBP) values of newly admitted treatment-resistant persons with Type II diabetes (n = 46) at baseline and at 3, 6 and 12 months following admission. Bar represents mean change in BP compared to baseline values and error bars represent 95% confidence intervals (CI). *Significantly different from 0 (p < 0.05).
See this image and copyright information in PMC

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