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

Oct 19, 2010

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