Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: A multi-center randomized controlled trial
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. Randomized-controlled-trial in three US Veteran Health Administration (VHA) Hospitals, where 250 patients with T2DM, HbA1c >7%...
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| creator | Wu, Wen-Chih Taveira, Tracey H Jeffery, Sean Jiang, Lan Tokuda, Lisa Musial, Joanna Cohen, Lisa B Uhrle, Fred |
| description | 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.
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.
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 |
| doi_str_mv | 10.1371/journal.pone.0195898 |
| format | Article |
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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.
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).
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.
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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.
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).
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.
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economics</subject><subject>Pharmacists</subject><subject>Practice</subject><subject>Primary care</subject><subject>Primary Health Care - economics</subject><subject>R&D</subject><subject>Randomization</subject><subject>Research & development</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Smoking</subject><subject>Systematic review</subject><subject>Type 2 diabetes</subject><subject>United States - epidemiology</subject><subject>Veterans</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk99r1TAUx4sobk7_A9GCIPrQa9K0SeqDMC7-GAwGOnwN57Yn92akzV2SXpwP_u2mWzd2ZQ_Sh5Tk8_0m53s4WfaSkgVlgn64cKMfwC62bsAFoU0tG_koO6QNKwteEvb43v9B9iyEC0JqJjl_mh2UDRdlzcVh9mfpQgw5DF2OWmMbzQ4HDCF3Ot9uwPfQmhALi12-9m7c5j12pgWb70wwSaidz-PVFosy7wysMGL4mB_n_WijKVocIvrcJ3fXm9_Jo3VD9M5OdtEbsM-zJxpswBfzepSdf_l8vvxWnJ59PVkenxYtb8pYoMaqraTWFVSYaqWU1aksRKmJ1qQRHeVUCF7JRnMUQDvCG-ArFKQtqxU7yl7f2G6tC2pOLqiSlIIzJps6ESc3ROfgQm296cFfKQdGXW84v1bgo2ktKrECEEkCRMqKggApNeCKUo4pXcmT16f5tnGV4ppS8GD3TPdPBrNRa7dTdUMkFWUyeDcbeHc5YoiqN6FFa2FAN16_O71ZUjqhb_5BH65uptaQCjCDdunedjJVxzWrGRM1m7wWD1Dp67A3qXOoTdrfE7zfE0zdxV9xDWMI6uTH9_9nz37us2_vsRsEGzfB2TEaN4R9sLoBW-9C8KjvQqZETVNym4aapkTNU5Jkr-436E50OxbsL_flDd0</recordid><startdate>20180419</startdate><enddate>20180419</enddate><creator>Wu, Wen-Chih</creator><creator>Taveira, Tracey H</creator><creator>Jeffery, Sean</creator><creator>Jiang, Lan</creator><creator>Tokuda, Lisa</creator><creator>Musial, Joanna</creator><creator>Cohen, Lisa B</creator><creator>Uhrle, Fred</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-2834-2024</orcidid></search><sort><creationdate>20180419</creationdate><title>Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: A multi-center randomized controlled trial</title><author>Wu, Wen-Chih ; Taveira, Tracey H ; Jeffery, Sean ; Jiang, Lan ; Tokuda, Lisa ; Musial, Joanna ; Cohen, Lisa B ; Uhrle, Fred</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-efe4c48ff4a4e0191135203ee8f0ff097d161776489f6e7a1d069a6be70c24b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Activities of daily living</topic><topic>Aged</topic><topic>Ambulatory Care - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wu, Wen-Chih</au><au>Taveira, Tracey H</au><au>Jeffery, Sean</au><au>Jiang, Lan</au><au>Tokuda, Lisa</au><au>Musial, Joanna</au><au>Cohen, Lisa B</au><au>Uhrle, Fred</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: A multi-center randomized controlled trial</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-04-19</date><risdate>2018</risdate><volume>13</volume><issue>4</issue><spage>e0195898</spage><epage>e0195898</epage><pages>e0195898-e0195898</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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.
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).
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.
NCT00554671 ClinicalTrials.gov.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29672567</pmid><doi>10.1371/journal.pone.0195898</doi><tpages>e0195898</tpages><orcidid>https://orcid.org/0000-0002-2834-2024</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_2027633895 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Activities of daily living Aged Ambulatory Care - economics Analysis Biology and life sciences Blood pressure Cardiovascular disease Cardiovascular diseases Collaboration Comorbidity Control methods Cost control Cost-Benefit Analysis Diabetes Diabetes mellitus Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - epidemiology Diabetes therapy Drug stores Drug therapy Education Female Glucose Health care costs Health care expenditures Health care policy Health risks Hemoglobin Hospital administration Hospitals, Veterans Humans Hyperlipidemia Hypertension Intervention Islands Low density lipoprotein Male Medicine and Health Sciences Middle Aged Patient Acceptance of Health Care Patients People and Places Pharmaceutical Services - economics Pharmacists Practice Primary care Primary Health Care - economics R&D Randomization Research & development Risk analysis Risk factors Smoking Systematic review Type 2 diabetes United States - epidemiology Veterans |
| title | Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: A multi-center randomized controlled trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T08%3A24%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Costs%20and%20effectiveness%20of%20pharmacist-led%20group%20medical%20visits%20for%20type-2%20diabetes:%20A%20multi-center%20randomized%20controlled%20trial&rft.jtitle=PloS%20one&rft.au=Wu,%20Wen-Chih&rft.date=2018-04-19&rft.volume=13&rft.issue=4&rft.spage=e0195898&rft.epage=e0195898&rft.pages=e0195898-e0195898&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0195898&rft_dat=%3Cgale_plos_%3EA535337532%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2027633895&rft_id=info:pmid/29672567&rft_galeid=A535337532&rft_doaj_id=oai_doaj_org_article_7baa7953a08841a7a88faeb116e86686&rfr_iscdi=true |