AHA 2024: Integrating Ambulatory Care Pharmacists in Value-Based Primary Care Improves Cardiometabolic Disease Management

Integrating pharmacists with collaborative drug therapy management (CDTM) agreements in Village Medical clinics improved indicators of chronic disease control, including systolic blood pressure and hemoglobin A1c (HbA1c), according to a poster presented at the American Heart Association (AHA) Scientific Sessions 2024.¹

Pharmacist talking to an older woman | Image credit: © C. Davids/peopleimages.com | stock.adobe.com

Chronic disease management is incredibly common, but it is associated with high costs and complicated treatment regimens. Value-based payment models are becoming increasingly common, leading clinicians to find novel ways to engage patients and improve disease control with the goal of reducing morbidity, mortality, and cost.¹

Medication access, adherence, and optimization are all closely linked and have significant impacts in value-based care models. Importantly, pharmacists play crucial roles in all 3. Financial barriers have great impacts on patients’ medication adherence rates, which are key indicators when evaluating the performance of Medicare Advantage and Part D plans in Medicare STAR ratings. According to Chess Health Solutions, medication adherence, particularly for chronic conditions, accounts for up to 41% of overall rating.²

Furthermore, medication optimization has a direct impact on value-based care evaluations. Not only do pharmacists assess the efficacy, safety, and relevance of prescription medications, but they also evaluate OTC medications, vitamins, and supplements to ensure the entire treatment regimen is optimized for each patient.²

Pharmacists and pharmacy technicians are also involved in disease state programs, such as those for diabetes and hypertension. Research has shown that pharmacist interventions improve disease control and result in fewer complications and reduced hospitalizations.²

The AHA poster is one of many studies highlighting the value of pharmacists in cardiometabolic care. In one paper, authors highlighted the wide variety of services pharmacies can provide for cardiovascular prevention and management, including education activities for patients, informative activities for health care professionals, direct intervention in a multidisciplinary team, and more.³

As highly accessible health care professionals, pharmacists are in a unique position to educate and care for patients. From screening to treatment initiation and follow-up, pharmacists have proven to be essential team members. Randomized controlled and observational studies have demonstrated that interventions provided by pharmacists are beneficial in the management of major cardiovascular risk factors, including hypertension, dyslipidemia, diabetes, and smoking cessation. One literature review noted that greater pharmacist involvement in patient-directed activities and collaboration with other health care providers enhances the effects on various outcomes and may ultimately positively impact public health.³

In the poster presented at the Scientific Sessions, researchers hypothesized that integrating a Walgreens pharmacist with CDTM agreements into Village Medical clinics would improve indicators of chronic disease control. Specifically, the goal was to improve HbA1c in individuals with type 2 diabetes and systolic blood pressure and diastolic blood pressure measurements in individuals with hypertension.¹

Investigators embedded an ambulatory pharmacist into clinics in Phoenix, Arizona, under the supervision of Village Medical primary care providers via the CDTM agreements. The pharmacist provided education, coaching, and medication management by prescribing and titrating therapies for both type 2 diabetes and hypertension, utilizing access to pharmacy dispensing data. The b was generated from difference-in-differences analyses with propensity score-matched controls.¹

In total, 125 patients had type 2 diabetes and 43 had hypertension in the intervention group, with 250 and 86, respectively, in the matched control group. Participants had a mean age of 65 years, 54% were female, 2% were non-English speaking, and 29% were racial or ethnic minorities. The average baseline HbA1c measurement was 9% in the intervention group and 10% in the matched cohort, whereas the average baseline systolic blood pressure was 146 mmHg in the intervention group and 142 mmHg in the matched cohort.¹

According to the researchers, the b in the type 2 diabetes group was -1.61% (p<0.0001) whereas the b in the hypertension group was -10.2 mmHg (p<0.01) for systolic blood pressure and -2.0 mmHg (p=0.42) for diastolic blood pressure. This result demonstrates significant reductions in both systolic blood pressure and HbA1c in the pharmacist-managed group compared with matched controls, showing that pharmacist integration in clinics may improve measures of chronic disease associated with morbidity and mortality.¹

REFERENCES

1. Blood A, Saag H, Chesler A, et al. Integrating ambulatory care pharmacists into value-based primary care: a scalable model for addressing cardiometabolic disease. Presented at: American Heart Association Scientific Sessions 2024. November 17, 2024. Accessed November 17, 2024. https://aha.apprisor.org/epsAbstractAHA.cfm?id=2

2. Grandy R. Making the Best Use of Medications for Every Patient: The Role of Pharmacy in Value-based Care. Chess Health Solutions. June 20, 2024. Accessed November 17, 2024. https://www.chesshealthsolutions.com/2024/06/20/the-role-of-pharmacy-in-value-based-care/

3. Omboni S, Caserini M. Effectiveness of pharmacist’s intervention in the management of cardiovascular diseases. Open Heart. 2018;5(1). doi:10.1136/openhrt-2017-000687