How Pharmacists Can Improve Care for Chronic Conditions

Patients with chronic conditions who receive care from pharmacists may be more likely to reach their blood glucose, blood pressure, and cholesterol goals.

A new review published in the Annals of Internal Medicine lends evidence-based support to the belief that pharmacists are skilled in providing chronic care management.

The researchers behind this finding noted that pharmacists are focusing more on patient-centered care, which will help expand access to health care services and potentially improve patient outcomes. Before they conducted their review, however, questions about the effectiveness and/or harms of pharmacist-led care for chronic conditions remained.

Review author Nancy Greer, PhD, of the Minneapolis Veterans Affairs (VA) Medical Center, told Pharmacy Times that this topic was nominated by the VA Pharmacy Benefits Management Program through the VA Evidence-Based Synthesis Program. In order to thoroughly explore it, the investigators examined data from MEDLINE and the International Pharmaceutical Abstracts dated between 1995 and February 2016, in addition to reference lists of systematic reviews and included studies.

In total, their review involved 65 patient populations from 63 studies that compared outcomes of pharmacist-led chronic disease management with those of usual care that didn’t include services provided by a pharmacist. (Of note, studies involving retail pharmacies were not included.)

The researchers discovered that pharmacist-led care produced a similar number of office visits, urgent care or emergency department visits, and hospitalizations compared with usual care. Medication adherence, mortality, and clinical events were also similar between the pharmacist and usual care groups.

Meanwhile, patient satisfaction reports were insufficient to draw any conclusions. Notably, however, pharmacists’ care was associated with an increased number or dose of medications and improved glycemic, blood pressure, and lipid goal attainment.

“Patients receiving pharmacist-led chronic disease management were more likely to attain selected goals for blood glucose, blood pressure, and cholesterol levels compared with patients receiving usual care,” Dr. Greer said. “However, it is not known whether achieving these targets improves clinical outcomes without undue harms and costs.”

She explained that for clinical outcomes such as clinical events, all-cause mortality, patient satisfaction, quality of life, and access to care, there’s still limited evidence on the effectiveness and harms of pharmacist-led chronic disease management compared with usual care.

In light of this, the investigators called for more studies to determine whether greater medication use and goal attainment actually improve clinical outcomes.

Some of the limitations of their research included that the studies were usually short-term and aimed at physiologic intermediate outcomes instead of clinical events. The pharmacist-led interventions were performed in different ways, as well.

A single investigator performed the data extraction for this review, but a second investigator confirmed it. In addition, 2 other investigators examined risk of bias.

Previous research has found that pharmacist-led interventions can boost medication adherence among patients with chronic conditions.

In one study published in Health Affairs, Rite Aid pharmacists made it easier for patients to get prescriptions refilled by doing things like calling the prescriber when patients were out of refills and using an automated refill program. In addition, the pharmacists called patients to remind them when their medication was due to be refilled.

“Being able to identify patients who are nonadherent or are at risk of being nonadherent is the key to being able to appropriately focus the pharmacist’s attention on addressing the concerns of the patient and breaking down barriers that exist,” Jesse McCullough, PharmD, director of field clinical services for Rite Aid and co-author of the study, told Pharmacy Times.

In another study, patients with diabetes who visited a pharmacist-led clinic saw their HbA1C levels drop by 2.4%. During the intervention, a pharmacist, who was also a Certified Diabetes Educator, simplified patients’ drug regimens, focused on medication adherence, and set goals. The patients were also able to make follow-up calls to the pharmacist if they had any questions.

Pharmacists have also proven their skills in improving blood pressure and cholesterol following a stroke.

One study examined stroke patients who had a monthly visit with either a nurse or a pharmacist. Although both groups recorded improvements, the patients who met with a pharmacist saw significantly greater improvements than those who met with a nurse.