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Adding Pharmacists to Primary Care Teams in Patients with Type 2 Diabetes

The study was done to evaluate the effect of adding pharmacists to primary care teams on management of hypertension and other cardiovascular risk factors in patients with Type 2 diabetes….

The randomized controlled trial with blinded ascertainment of outcomes was conducted in primary care clinics in Edmonton, Canada. Pharmacists performed medication assessments, limited history and physical examinations, and provided guideline-concordant recommendations to optimize medication management. Follow-up contact was completed as necessary. Controls received usual care. The primary outcome was a ≥10% decrease in systolic blood pressure (BP) at 1 year.

260 patients were enrolled, 57% were women, mean age was 59 years, diabetes duration was 6 years and BP was 129/74 mmHg. 48 of 131 (37%) intervention patients and 30 of 129 (23%) controls achieved the primary outcome (OR 1.9; 95% CI 1.1-3.3; p=0.02). Among the 153 patients with inadequately controlled hypertension at baseline, intervention patients (n=82) were significantly more likely than controls (n=71) to achieve the primary outcome (41[50%] vs. 20[28%]; OR 2.6; 95% CI 1.3-5.0; p=0.007) and recommended BP targets (44[54%] vs. 21[30%]; OR 2.8; 95% CI 1.4-5.4; p=0.003). Ten-year risk of cardiovascular disease, based on changes to the UKPDS Risk Engine, were predicted to decrease by 3% for intervention patients and 1% for controls (p=0.005).

From the results the observations support the addition of pharmacists to primary care teams.

Working in collaboration with the patient, primary care physician, and other healthcare professionals, pharmacists can have a significant, positive impact on blood pressure management in Type 2 diabetes. Researchers believe the results are applicable to a broad range of patients with Type 2 diabetes managed in primary care settings, and can be extended to non-diabetic patients with inadequately controlled hypertension.

Diabetes Care Oct. 2010