Diabetes Behind Bars: Pharmacists Help Control HbA1C in Inmates

Did you know that diabetes is a common problem in prisons?

The Federal Bureau of Prisons currently treats 13,000 patients to prevent and delay diabetic complications. Of note, the bureau has successfully incorporated pharmacists into its primary care workforce to ease its provider shortage and improve patient outcomes.

Pharmacist-run diabetes clinics measure each inmate’s HbA1C, blood pressure, and low-density lipoprotein cholesterol levels at baseline and periodically.

The bureau’s pharmacists have operated under physician-pharmacist collaborative practice agreements for 20 years, and they practice under a nationwide agreement. Back in 2014, the bureau created a standard drug utilization evaluation tool to assess diabetic patients’ clinical improvement.

A study published in the March/April 2016 issue of the Journal of the American Pharmacists Association looked specifically at HbA1C, and the bureau’s pharmacists intervened aggressively to adjust medications when patients’ diabetes was uncontrolled. They followed up with these patients every 1 to 2 weeks to determine each intervention’s effectiveness.

Pharmacist-run clinics enroll some of the most difficult-to-control patients (eg, patients having mean HbA1C of 10.6% at baseline). Pharmacist intervention decreased mean HbA1C by 2.3%, down to a mean of 8.3%.

HbA1C change is clinically important, even if patients do not meet evidence-based guideline goals, because a 1% absolute decrease in HbA1C reduces diabetic complication risk by up to 40%.

The bureau’s pharmacists also serve in anticoagulation, HIV, and mental health clinics. Their interventions have improved international normalized ratio control by 94% (74% patients at goal), HIV viral load control by 65% (74% of patients at goal), and highly active antiretroviral therapy adherence by 17% (98% adherence rate).

The bureau advises pharmacists who wish to start clinical programs to consider the following:

· Seeking pharmacist and physician buy-in

· Enrolling the sickest patients to encourage physician buy-in

· Starting small and growing clinics slowly

The bureau’s pharmacist-run clinics are great examples for the entire health care system to follow when initiating pharmacist-involved primary care programs. Its top-down standardized approach produces consistent improvement in patient outcomes and demonstrates how pharmacists’ expertise complements other primary care providers’ care.