Evaluation of a Pharmacist-Managed Diabetes Program in a Primary Care Setting Within an Integrated Health Care System
Pharmacists have important roles in managing the therapy of patients with type 2 diabetes and improving patient care. Pharmacists titrate medications; reinforce patient education; and address care gaps, such as medication adherence, vaccinations, and overdue health screenings. Through these efforts...
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| Veröffentlicht in: | Journal of managed care & specialty pharmacy 2018-02, Vol.24 (2), p.114-122 |
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| creator | Benedict, Amanda W Spence, Michele M Sie, John L Chin, Helen A Ngo, Chi D Salmingo, Jennifer F Vidaurreta, Andrew T Rashid, Nazia |
| description | Pharmacists have important roles in managing the therapy of patients with type 2 diabetes and improving patient care. Pharmacists titrate medications; reinforce patient education; and address care gaps, such as medication adherence, vaccinations, and overdue health screenings. Through these efforts and more, pharmacists help to improve patient care and achieve Healthcare Effectiveness Data and Information Set (HEDIS) measures. Thus, it is important to demonstrate improved health outcomes through pharmacist contributions to diabetes management, which can then provide an opportunity to expand the role of clinical pharmacists in other medical centers and practice settings within an integrated health care system.
To evaluate the effect of a pharmacist-managed program within a primary care setting by determining the percentage of patients who reached the HEDIS goal of hemoglobin A1c (A1c) < 8.0%, the time needed to reach this goal, and A1c reduction in patients with type 2 diabetes.
This retrospective cohort study identified patients aged 18-74 years who had uncontrolled A1c ≥ 8.0%. Patients in the Complete Care Program (CCP) had their diabetes therapy managed by a pharmacist and were propensity score matched to a comparison group of usual care (UC) patients. Multivariate regression analyses and a Cox proportional hazards model compared the change in A1c from baseline and the time to A1c goal between the 2 groups.
There were no significant differences in baseline characteristics between the CCP and UC patients (n = 980 patients per group). CCP patients were significantly more likely to achieve the HEDIS goal of A1c < 8% at 3 months (OR = 2.44, 95% CI = 1.93-3.10, P < 0.0001) and at 6 months (OR = 1.32, 95% CI = 1.08-1.61, P = 0.007) compared with the UC patients. CCP patients also reached the A1c goal significantly faster: 3.4 months versus 4.6 months (P < 0.0001), even after controlling for covariates (HR = 1.24, 95% CI = 1.09-1.41, P = 0.001). Change in baseline A1c was -0.95% versus -0.54% (P < 0.0001) at 3 months and -1.19% versus -0.99% (P = 0.008) at 6 months for CCP versus UC patients, respectively.
Type 2 diabetes therapy management by clinical pharmacists was associated with a greater percentage of patients achieving the HEDIS goal of A1c < 8.0%, reaching the A1c goal faster, and a greater A1c reduction from baseline at 3 and 6 months of follow-up compared with patients receiving usual care.
No funding was provided to support this research study. The a |
| doi_str_mv | 10.18553/jmcp.2018.24.2.114 |
| format | Article |
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To evaluate the effect of a pharmacist-managed program within a primary care setting by determining the percentage of patients who reached the HEDIS goal of hemoglobin A1c (A1c) < 8.0%, the time needed to reach this goal, and A1c reduction in patients with type 2 diabetes.
This retrospective cohort study identified patients aged 18-74 years who had uncontrolled A1c ≥ 8.0%. Patients in the Complete Care Program (CCP) had their diabetes therapy managed by a pharmacist and were propensity score matched to a comparison group of usual care (UC) patients. Multivariate regression analyses and a Cox proportional hazards model compared the change in A1c from baseline and the time to A1c goal between the 2 groups.
There were no significant differences in baseline characteristics between the CCP and UC patients (n = 980 patients per group). CCP patients were significantly more likely to achieve the HEDIS goal of A1c < 8% at 3 months (OR = 2.44, 95% CI = 1.93-3.10, P < 0.0001) and at 6 months (OR = 1.32, 95% CI = 1.08-1.61, P = 0.007) compared with the UC patients. CCP patients also reached the A1c goal significantly faster: 3.4 months versus 4.6 months (P < 0.0001), even after controlling for covariates (HR = 1.24, 95% CI = 1.09-1.41, P = 0.001). Change in baseline A1c was -0.95% versus -0.54% (P < 0.0001) at 3 months and -1.19% versus -0.99% (P = 0.008) at 6 months for CCP versus UC patients, respectively.
Type 2 diabetes therapy management by clinical pharmacists was associated with a greater percentage of patients achieving the HEDIS goal of A1c < 8.0%, reaching the A1c goal faster, and a greater A1c reduction from baseline at 3 and 6 months of follow-up compared with patients receiving usual care.
No funding was provided to support this research study. The authors report no potential conflicts of interest relevant to this article. All authors contributed to the study concept and design. Benedict and Spence performed data analysis and interpretation. The manuscript was written by Benedict, with assistance from Spence and Rashid. All authors reviewed and contributed to manuscript revisions. Spence is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Parts of this study were presented at the AMCP Managed Care and Specialty Pharmacy Annual Meeting; San Francisco, California; April 19-22, 2016.]]></description><identifier>ISSN: 2376-0540</identifier><identifier>EISSN: 2376-1032</identifier><identifier>DOI: 10.18553/jmcp.2018.24.2.114</identifier><identifier>PMID: 29384029</identifier><language>eng</language><publisher>United States: Academy of Managed Care Pharmacy</publisher><subject><![CDATA[Adolescent ; Adult ; Aged ; Biomarkers - blood ; Blood Glucose - drug effects ; Blood Glucose - metabolism ; Chi-Square Distribution ; Community Pharmacy Services - organization & administration ; Delivery of Health Care, Integrated - organization & administration ; Diabetes Mellitus, Type 2 - blood ; Diabetes Mellitus, Type 2 - diagnosis ; Diabetes Mellitus, Type 2 - drug therapy ; Female ; Glycated Hemoglobin - metabolism ; Health Status ; Humans ; Hypoglycemic Agents - therapeutic use ; Interdisciplinary Communication ; Logistic Models ; Male ; Managed Care Programs - organization & administration ; Medication Adherence ; Middle Aged ; Multivariate Analysis ; Patient Care Team - organization & administration ; Patient Education as Topic - organization & administration ; Pharmacists - organization & administration ; Primary Health Care - organization & administration ; Professional Role ; Program Evaluation ; Proportional Hazards Models ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Vaccination ; Young Adult]]></subject><ispartof>Journal of managed care & specialty pharmacy, 2018-02, Vol.24 (2), p.114-122</ispartof><rights>Copyright © 2018, Academy of Managed Care Pharmacy. All rights reserved. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c406t-b9b5e6d35bafe6310bf08d3003e36bad6229e99235974a2f083b5d50d6b78fe3</citedby><cites>FETCH-LOGICAL-c406t-b9b5e6d35bafe6310bf08d3003e36bad6229e99235974a2f083b5d50d6b78fe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10398151/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10398151/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29384029$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Benedict, Amanda W</creatorcontrib><creatorcontrib>Spence, Michele M</creatorcontrib><creatorcontrib>Sie, John L</creatorcontrib><creatorcontrib>Chin, Helen A</creatorcontrib><creatorcontrib>Ngo, Chi D</creatorcontrib><creatorcontrib>Salmingo, Jennifer F</creatorcontrib><creatorcontrib>Vidaurreta, Andrew T</creatorcontrib><creatorcontrib>Rashid, Nazia</creatorcontrib><title>Evaluation of a Pharmacist-Managed Diabetes Program in a Primary Care Setting Within an Integrated Health Care System</title><title>Journal of managed care & specialty pharmacy</title><addtitle>J Manag Care Spec Pharm</addtitle><description><![CDATA[Pharmacists have important roles in managing the therapy of patients with type 2 diabetes and improving patient care. Pharmacists titrate medications; reinforce patient education; and address care gaps, such as medication adherence, vaccinations, and overdue health screenings. Through these efforts and more, pharmacists help to improve patient care and achieve Healthcare Effectiveness Data and Information Set (HEDIS) measures. Thus, it is important to demonstrate improved health outcomes through pharmacist contributions to diabetes management, which can then provide an opportunity to expand the role of clinical pharmacists in other medical centers and practice settings within an integrated health care system.
To evaluate the effect of a pharmacist-managed program within a primary care setting by determining the percentage of patients who reached the HEDIS goal of hemoglobin A1c (A1c) < 8.0%, the time needed to reach this goal, and A1c reduction in patients with type 2 diabetes.
This retrospective cohort study identified patients aged 18-74 years who had uncontrolled A1c ≥ 8.0%. Patients in the Complete Care Program (CCP) had their diabetes therapy managed by a pharmacist and were propensity score matched to a comparison group of usual care (UC) patients. Multivariate regression analyses and a Cox proportional hazards model compared the change in A1c from baseline and the time to A1c goal between the 2 groups.
There were no significant differences in baseline characteristics between the CCP and UC patients (n = 980 patients per group). CCP patients were significantly more likely to achieve the HEDIS goal of A1c < 8% at 3 months (OR = 2.44, 95% CI = 1.93-3.10, P < 0.0001) and at 6 months (OR = 1.32, 95% CI = 1.08-1.61, P = 0.007) compared with the UC patients. CCP patients also reached the A1c goal significantly faster: 3.4 months versus 4.6 months (P < 0.0001), even after controlling for covariates (HR = 1.24, 95% CI = 1.09-1.41, P = 0.001). Change in baseline A1c was -0.95% versus -0.54% (P < 0.0001) at 3 months and -1.19% versus -0.99% (P = 0.008) at 6 months for CCP versus UC patients, respectively.
Type 2 diabetes therapy management by clinical pharmacists was associated with a greater percentage of patients achieving the HEDIS goal of A1c < 8.0%, reaching the A1c goal faster, and a greater A1c reduction from baseline at 3 and 6 months of follow-up compared with patients receiving usual care.
No funding was provided to support this research study. The authors report no potential conflicts of interest relevant to this article. All authors contributed to the study concept and design. Benedict and Spence performed data analysis and interpretation. The manuscript was written by Benedict, with assistance from Spence and Rashid. All authors reviewed and contributed to manuscript revisions. Spence is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Parts of this study were presented at the AMCP Managed Care and Specialty Pharmacy Annual Meeting; San Francisco, California; April 19-22, 2016.]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biomarkers - blood</subject><subject>Blood Glucose - drug effects</subject><subject>Blood Glucose - metabolism</subject><subject>Chi-Square Distribution</subject><subject>Community Pharmacy Services - organization & administration</subject><subject>Delivery of Health Care, Integrated - organization & administration</subject><subject>Diabetes Mellitus, Type 2 - blood</subject><subject>Diabetes Mellitus, Type 2 - diagnosis</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Female</subject><subject>Glycated Hemoglobin - metabolism</subject><subject>Health Status</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Interdisciplinary Communication</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Managed Care Programs - organization & administration</subject><subject>Medication Adherence</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Patient Care Team - organization & administration</subject><subject>Patient Education as Topic - organization & administration</subject><subject>Pharmacists - organization & administration</subject><subject>Primary Health Care - organization & administration</subject><subject>Professional Role</subject><subject>Program Evaluation</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vaccination</subject><subject>Young Adult</subject><issn>2376-0540</issn><issn>2376-1032</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUdtqwkAQXUpLFesXFMr-QNK9ZGPyVIq1VbBUqNDHZTaZ6IpJZLMK_n2TaqV9moFzmcsh5J6zkCdKycdNme1CwXgSiigUIefRFekLOYoDzqS4PvdMRaxHhk2zYYwJqeKEy1vSE6lMIibSPtlPDrDdg7d1ReuCAl2swZWQ2cYH71DBCnP6YsGgx4YuXL1yUFJbdURnS3BHOgaH9BO9t9WKflm_7tCKziqPLdm3-inC1q_PxGPjsbwjNwVsGxye64AsXyfL8TSYf7zNxs_zIItY7AOTGoVxLpWBAmPJmSlYkkvGJMrYQB4LkWKatnelowhEC0qjcsXy2IySAuWAPJ1sd3tTYp5h5R1s9e60ua7B6v9IZdd6VR90-8I04Yq3DvLkkLm6aRwWFzFn-icI3QWhuyC0iLTQbRCt6uHv3Ivm9-3yG7Zphvg</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Benedict, Amanda W</creator><creator>Spence, Michele M</creator><creator>Sie, John L</creator><creator>Chin, Helen A</creator><creator>Ngo, Chi D</creator><creator>Salmingo, Jennifer F</creator><creator>Vidaurreta, Andrew T</creator><creator>Rashid, Nazia</creator><general>Academy of Managed Care Pharmacy</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>5PM</scope></search><sort><creationdate>201802</creationdate><title>Evaluation of a Pharmacist-Managed Diabetes Program in a Primary Care Setting Within an Integrated Health Care System</title><author>Benedict, Amanda W ; Spence, Michele M ; Sie, John L ; Chin, Helen A ; Ngo, Chi D ; Salmingo, Jennifer F ; Vidaurreta, Andrew T ; Rashid, Nazia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-b9b5e6d35bafe6310bf08d3003e36bad6229e99235974a2f083b5d50d6b78fe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biomarkers - blood</topic><topic>Blood Glucose - drug effects</topic><topic>Blood Glucose - metabolism</topic><topic>Chi-Square Distribution</topic><topic>Community Pharmacy Services - organization & administration</topic><topic>Delivery of Health Care, Integrated - organization & administration</topic><topic>Diabetes Mellitus, Type 2 - blood</topic><topic>Diabetes Mellitus, Type 2 - diagnosis</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Female</topic><topic>Glycated Hemoglobin - metabolism</topic><topic>Health Status</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Interdisciplinary Communication</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Managed Care Programs - organization & administration</topic><topic>Medication Adherence</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Patient Care Team - organization & administration</topic><topic>Patient Education as Topic - organization & administration</topic><topic>Pharmacists - organization & administration</topic><topic>Primary Health Care - organization & administration</topic><topic>Professional Role</topic><topic>Program Evaluation</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vaccination</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Benedict, Amanda W</creatorcontrib><creatorcontrib>Spence, Michele M</creatorcontrib><creatorcontrib>Sie, John L</creatorcontrib><creatorcontrib>Chin, Helen A</creatorcontrib><creatorcontrib>Ngo, Chi D</creatorcontrib><creatorcontrib>Salmingo, Jennifer F</creatorcontrib><creatorcontrib>Vidaurreta, Andrew T</creatorcontrib><creatorcontrib>Rashid, Nazia</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of managed care & specialty pharmacy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Benedict, Amanda W</au><au>Spence, Michele M</au><au>Sie, John L</au><au>Chin, Helen A</au><au>Ngo, Chi D</au><au>Salmingo, Jennifer F</au><au>Vidaurreta, Andrew T</au><au>Rashid, Nazia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of a Pharmacist-Managed Diabetes Program in a Primary Care Setting Within an Integrated Health Care System</atitle><jtitle>Journal of managed care & specialty pharmacy</jtitle><addtitle>J Manag Care Spec Pharm</addtitle><date>2018-02</date><risdate>2018</risdate><volume>24</volume><issue>2</issue><spage>114</spage><epage>122</epage><pages>114-122</pages><issn>2376-0540</issn><eissn>2376-1032</eissn><abstract><![CDATA[Pharmacists have important roles in managing the therapy of patients with type 2 diabetes and improving patient care. Pharmacists titrate medications; reinforce patient education; and address care gaps, such as medication adherence, vaccinations, and overdue health screenings. Through these efforts and more, pharmacists help to improve patient care and achieve Healthcare Effectiveness Data and Information Set (HEDIS) measures. Thus, it is important to demonstrate improved health outcomes through pharmacist contributions to diabetes management, which can then provide an opportunity to expand the role of clinical pharmacists in other medical centers and practice settings within an integrated health care system.
To evaluate the effect of a pharmacist-managed program within a primary care setting by determining the percentage of patients who reached the HEDIS goal of hemoglobin A1c (A1c) < 8.0%, the time needed to reach this goal, and A1c reduction in patients with type 2 diabetes.
This retrospective cohort study identified patients aged 18-74 years who had uncontrolled A1c ≥ 8.0%. Patients in the Complete Care Program (CCP) had their diabetes therapy managed by a pharmacist and were propensity score matched to a comparison group of usual care (UC) patients. Multivariate regression analyses and a Cox proportional hazards model compared the change in A1c from baseline and the time to A1c goal between the 2 groups.
There were no significant differences in baseline characteristics between the CCP and UC patients (n = 980 patients per group). CCP patients were significantly more likely to achieve the HEDIS goal of A1c < 8% at 3 months (OR = 2.44, 95% CI = 1.93-3.10, P < 0.0001) and at 6 months (OR = 1.32, 95% CI = 1.08-1.61, P = 0.007) compared with the UC patients. CCP patients also reached the A1c goal significantly faster: 3.4 months versus 4.6 months (P < 0.0001), even after controlling for covariates (HR = 1.24, 95% CI = 1.09-1.41, P = 0.001). Change in baseline A1c was -0.95% versus -0.54% (P < 0.0001) at 3 months and -1.19% versus -0.99% (P = 0.008) at 6 months for CCP versus UC patients, respectively.
Type 2 diabetes therapy management by clinical pharmacists was associated with a greater percentage of patients achieving the HEDIS goal of A1c < 8.0%, reaching the A1c goal faster, and a greater A1c reduction from baseline at 3 and 6 months of follow-up compared with patients receiving usual care.
No funding was provided to support this research study. The authors report no potential conflicts of interest relevant to this article. All authors contributed to the study concept and design. Benedict and Spence performed data analysis and interpretation. The manuscript was written by Benedict, with assistance from Spence and Rashid. All authors reviewed and contributed to manuscript revisions. Spence is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Parts of this study were presented at the AMCP Managed Care and Specialty Pharmacy Annual Meeting; San Francisco, California; April 19-22, 2016.]]></abstract><cop>United States</cop><pub>Academy of Managed Care Pharmacy</pub><pmid>29384029</pmid><doi>10.18553/jmcp.2018.24.2.114</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of managed care & specialty pharmacy, 2018-02, Vol.24 (2), p.114-122 |
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| source | MEDLINE; PubMed Central |
| subjects | Adolescent Adult Aged Biomarkers - blood Blood Glucose - drug effects Blood Glucose - metabolism Chi-Square Distribution Community Pharmacy Services - organization & administration Delivery of Health Care, Integrated - organization & administration Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - drug therapy Female Glycated Hemoglobin - metabolism Health Status Humans Hypoglycemic Agents - therapeutic use Interdisciplinary Communication Logistic Models Male Managed Care Programs - organization & administration Medication Adherence Middle Aged Multivariate Analysis Patient Care Team - organization & administration Patient Education as Topic - organization & administration Pharmacists - organization & administration Primary Health Care - organization & administration Professional Role Program Evaluation Proportional Hazards Models Retrospective Studies Time Factors Treatment Outcome Vaccination Young Adult |
| title | Evaluation of a Pharmacist-Managed Diabetes Program in a Primary Care Setting Within an Integrated Health Care System |
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