Pharmacist-Led Intervention Could Improve Type 2 Diabetes Outcomes for Hispanic Patients

Pharmacist-led interventions could help to improve some outcomes for Hispanic patients with type 2 diabetes (T2D), according to the results of a study published in JAMA Network Open.

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The study authors noted that Hispanic patients are more likely to develop complications as a result of diabetes compared to those who are non-Hispanic White. The authors stated that factors that contributed to these disparities included “lower levels of treatment intensification” and “reduced adherence to diabetes medications.” The investigators aimed to determine whether pharmacists could lead an intervention with hemoglobin A1C (HbA1C) to impact systolic blood pressure and diabetes outcomes for the patient population.

They used electronic health record data and the difference-in-differences study design to evaluate pharmacist-led interventions and systolic blood pressure among patients at the University of California Los Angeles primary care clinics from March 2, 2013, to December 31, 2018. Patients in the study had a diagnosis of T2D, were self-reported Hispanic, aged 18 years or older, had 1 or more visits with a pharmacist for treatment, or 2 or more visits that were 2 or more years apart, but during the study window.

Patients also needed to have data on HbA1C of 8% or higher, anywhere between the 365 days before and 14 days after the date of the first visit or a randomly generated index date with a follow-up HbA1C measure within 120 to 365 days after the index date; and/or systolic blood pressure 140 mm Hg or higher between the 365 days before and 14 days after the index date, with a follow up measure between 120 and 450 days after the index date.

As part of the intervention, pharmacists reviewed laboratory results and vital signs, performed medication reconciliation, and personalized intervention to address the adherence barriers and care that fit within the guidelines for each patient.

The study population included 931 individuals with a mean age of 64 years, of whom 59% were female. Compared to the group who was not exposed to pharmacist intervention, those who were had a larger proportion of individuals aged 65 years and older, were female, were less likely to prefer English, had fewer individuals with private insurance, and a higher proportion with Medicare and Medicaid dual enrollment.

In the analysis, having 1 or more pharmacist visit was associated with a reduction in HbA1C concentration, but there were no changes in systolic blood pressure. A language-preference analysis showed a negative association, indicating a reduction between pharmacist-led intervention with HbA1C concentration among the subsample who preferred English language, but there was no significant trend among those with a non-English language preference. There was also no language association with systolic blood pressure, according to the study authors.

Furthermore, there was no significant associations between the HbA1C concentration and pharmacist intervention among those with more than the median number of visits and total contacts, as there was no association for systolic blood pressure.

Limitations of the study included non-observable factors and the lack of detailed data on the pharmacist-led interventions. The results also are not generalizable as the data came from academic health centers in southern California, so it may not reflect current clinical practices, according to the study authors.

Reference

Narain KDC, Moreno G, Bell DS, et al. Pharmacist-led diabetes control intervention and health outcomes in Hispanic patients with diabetes. JAMA Netw Open. 2023;6(9):e2335409. doi:10.1001/jamanetworkopen.2023.35409