Collaborative Diabetes Care Teams Help Lower HbA1C

While diabetes is a growing national health threat, it’s especially prevalent in Mississippi, where 1 in 8 residents are diabetic.

Previous projects such as the Asheville Project and Diabetes Ten City Challenge have demonstrated that community pharmacists can positively influence the primary care management of diabetes. Now, a recent article published in the Journal of Pharmacy Practice indicates that collaborative intervention improves several key clinical indicators of diabetes control.

The article described the impact of the American Pharmacists Association (APhA) Foundation’s Project IMPACT: Diabetes, which was designed to spur collaborative practice, improve clinical care quality, and help patients self-manage their diabetes.

This project set the following 4 objectives:

· Expand a proven community-based model of care in high-risk areas.

· Improve key indicators of diabetes care in targeted communities.

· Establish peer-to-peer mentoring to scale the existing model nationally.

· Create a sustainable platform for permanent change.

The article focused on the results of applying Project IMPACT: Diabetes at a physician-based clinic in Jackson, Mississippi, using a team of physicians, nurse practitioners, diabetes educators, and a pharmacist, who was new to the team. The researchers compared their results with the national cohort.

The Mississippi team enrolled patients prescribed diabetes medications who had HbA1C levels >7% within the past 3 months at enrollment and were able to reliably present to the clinic.

Patient HbA1C values decreased statistically and clinically significantly, with a mean decrease of 1.2% from an initial mean value of 9.2%. Nearly 1 in 4 (23.4%) patients reached their HbA1C goal, and an additional 37.5% reached an HbA1C level between 7.1% and 8%.

However, the researchers found that patients with initial HbA1C values >9% were unlikely to lower their HbAlC level below 9%.

The Mississippi cohort was more knowledgeable about diabetes (87.5% proficient or advanced), less likely to drop out of the project (9.9% vs 19.9%), and had larger reduction in HbA1C (1.2% vs 0.8%) than the national cohort.

Intervention increased the portion of patients meeting Joint National Committee (JNC) 7 and American Diabetes Association (ADA) 2012 blood pressure goal, which were the contemporary standards at the time of the study. However, the results were not clinically significant using the current JNC8 and ADA 2016 goals.

Pharmacist intervention also reduced influenza vaccine refusal by 21.4%.