Pharmacists As Part
of the Diabetes Team Improves Outcomes
Pharmacists achieve drops in HbA1c, lipids and
blood pressure.
After more then 45 years of just one oral drug available to treat
patients with Type 2 diabetes, we now find ourselves with a
dramatic increase in just a couple of years of new drugs and
combinations to treat patients with diabetes. The pharmacist who
is educated in all of these new treatments, interactions,
contradictions, etc, can play an important role as part of the
diabetes team.
An increasing number of disease management programs utilize
pharmacists to assist in the monitoring and management of patients
with diabetes. The VA Medical Center in Pittsburgh found that
persons with Type 2 diabetes who were enrolled in its
pharmacist-based program experienced significant improvements in
glycemic control within 6 months. After adjusting for the costs of
the program, it was estimated that the net savings to the VA
Medical Center for 15 of the most severely ill patients was more
than $103,000 per year.
In 1997, Fincham and Lofholm evaluated community pharmacists'
diabetes-related interventions and estimated the one-time
cost-savings from the prevention of hospitalizations or
unnecessary office visits were $4,295 per patient. A network of
community pharmacists saved the city of Asheville, North Carolina,
more than $900 per patient per year on diabetes care, while
several other authors have reported the positive impact of
pharmacist-based services on glycemic control. Nonetheless,
managed care organizations have not yet fully utilized community
pharmacists to improve the quality of diabetes care.
The objective of this pilot study was to determine whether the
diabetes patient-management program provided through the OVPCN was
an effective means of improving clinical outcomes in persons with
Type 2 diabetes.
A network of community pharmacies in West Virginia and
southeastern Ohio participated in the study. The program was
available to all patients with diabetes who attended the network
pharmacies regardless of baseline glycemic control. Of the 47
patients initially enrolled, 32 stayed in the program for at least
6 months during the year-long study (median time in program was 9
months).
The pharmacists provided a basic, standardized diabetes education
program during three 1-hour sessions. This was accompanied by a
clinical assessment and a report to the patient's primary care
physician. The patients met with the pharmacist every 3 months for
continued monitoring. After each visit, the patient's primary care
physician was sent a report along with recommendations for drug
therapy modification when appropriate.
HbA1c, blood pressure, total cholesterol, low-density lipoproteins
(LDL), high-density lipoproteins (HDL), triglycerides, body mass
index, and the number of drug therapy modifications were monitored
for outcomes
The results of the study showed that there was significant
improvement in total cholesterol (t=-2.58, p=0.015) and LDL
(t=-2.56, p=0.017) for the 32 participating patients. HbA1c, BMI,
blood pressure, HDL and triglycerides did not change significantly
across all patients. For a subgroup of 10 patients with baseline
HbA1c>8%, average HbA1c declined significantly from 9.8% to 8.6%
(t=-3.00, p=0.015). During the study, the 32 patients had a total
of 53 modifications to their medication regimens. The most common
was a change in dose of oral diabetes medications.
It was concluded that community pharmacists who have completed
additional training in diabetes care can have a beneficial impact
on the care of patients with Type 2 diabetes. Pharmacist-based
patient-management services not only help to improve glycemic
control in adults with HbA1c >8% but can also identify patients
with uncontrolled hypertension and dyslipidemia and produce
reductions in total cholesterol and LDL.
Therefore, pharmaceutical care may be beneficial for all patients
with diabetes regardless of baseline glycemic control.
Managed Care Pharm 8(1):48-53, 2002
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