Even with newer anti-diabetic agents and technology, primary care physicians today are still faced with barriers that prevent optimal disease management in their diabetic patients….
The Diabetes Initiative Program conducted a statewide effort out of Tennessee as a prospective, multicenter, cohort study evaluating the effect of collaboration between pharmacists and primary care physicians on outcomes of patients with diabetes.
Adults 18 yrs of age and older with type 2 diabetes, were enrolled in the study, conducted at seven practice sites across the state of Tennessee. Pregnant women, non-English speaking adults, or patients with a life expectancy less than 1 year were excluded. Patients were followed for 12-months. The primary outcomes of focus included reduction in hemoglobin A1c, percentage of patients achieving an A1c less than 7%, and percentage of patients with severely uncontrolled diabetes mellitus defined as A1c greater than 9%.
Patient follow-up visits were conducted either face-to-face or via telephone by a pharmacist, a physician, or as joint appointment. As part of the collaborative effort, pharmacists provided patient education, SMBG record monitoring, ordered laboratory testing and referral for immunizations and eye examinations. Furthermore, pharmacists provided medication management through initiation, adjustment or discontinuation of therapy.
The authors of the prospective study reported an average drop in hemoglobin A1c by 1.16%. With 206 patients enrolled in the study, the percentage of patients with an A1c less than 7% increased from 12.75% at baseline to 36.76% following the collaborative intervention. The authors also found an impact on patients with high A1c levels at baseline; for the percentage of patients with A1C greater than 9% decreased from 34.15% to 16.50%
Farland et al. reported "We believe that it is noteworthy that our study demonstrated an A1c reduction without an increase in either number of antihyperglycemic agents or rate of reported hypoglycemic episodes."
As demonstrated from the results, it was quite clear for the authors to conclude the collaborative effort between physicians and pharmacists demonstrated a significant improvement in the management of type 2 diabetes.
Farland,M., ByrdD., McFarland, S., et al., "Pharmacist-Physician Collaboration for Diabetes Care: The Diabetes Initiative Program." The Annals of Pharmacotherapy. May 8, 2013, doi: 10.1345/aph.1S079