Team Including Pharmacist Improves Diabetes Treatment

A diabetes care team that included a clinical pharmacist led to major improvements in glycemic control, LDL cholesterol levels, blood pressure, and long-term cardiovascular risk.

Adding a clinical pharmacist to a care team led to significant improvements in diabetes and cardiovascular markers as well as long-term cardiovascular risk, according to the results of a study published in the May 15, 2013, edition of the American Journal of Health-System Pharmacy. The study was carried out by researchers at Touro University California and Kaiser Permanente Medical Care Program.

The study retrospectively analyzed health outcomes for adult patients with type 2 diabetes (minimum baseline A1c of 7.0%) who received care through Kaiser Permanente Northern California. An enhanced care group, which included 147 patients, was treated by a team of providers including a clinical pharmacist. A control group, which included 147 matched patients, was treated by a primary care physician only. Patients in the 2 groups received care at different locations using the same clinical practice guidelines.

The clinical pharmacist involved in managing patients in the enhanced care group was a certified diabetes educator and pharmacotherapy specialist. The pharmacist held an initial 45-minute face-to-face meeting with each patient to evaluate their diabetes status and cardiovascular comorbidities. Through a collaborative practice agreement, the pharmacist also performed interventions including prescribing medication and adjusting dosages, ordering lab tests, recommending changes in diet and physical activity level, and providing diabetes self-care education materials. In addition, where appropriate, the pharmacist performed physical assessments, administered immunizations, and initiated referrals to specialists.

During the 12-month study period, the mean A1c decreased from 9.5% to 6.9% in the enhanced care group and from 9.3% to 8.4% in the control group. Of those in the enhanced care group, 92 (62.6%) reached the A1c goal of under 7.0%, 125 (85.0%) reached the LDL cholesterol goal of under 100 mg/dL, and 91 (61.6%) reached the blood pressure goal of under 130/80 mm/Hg. After adjusting for confounding factors, patients in the enhanced care group were significantly more likely than those in the control group to reach the A1c goal (odds ratio 3.9), the LDL cholesterol goal (odds ratio 2.0), the blood pressure goal (odds ratio 2.0), and to reach all 3 goals (odds ratio 3.2).

The enhanced care group also fared better in terms of long-term cardiovascular risk. The estimated 10-year risk of coronary heart disease (CHD) decreased from 16.4% to 9.3% in the enhanced care group and from 17.4% to 14.8% in the control group. In addition, the 10-year risk of fatal CHD decreased from 11.3% to 5.7% in the enhanced care group and from 11.9% to 10.3% in the control group.

“The study results presented here support the notion that adding a pharmacist to the primary care team is more effective than usual care in improving both short-term clinical markers and long-term cardiovascular risk in an HMO primary care setting,” the researchers write.

The researchers note, however, that their results need to be verified in a randomized, controlled study. They note as well that their study did not control for the difference in the number of diabetes-related clinic visits made by patients in the 2 groups. Enhanced care patients made more such visits on average, which may have helped produce more favorable results. However, at baseline, patients in the enhanced care group had had diabetes on average for longer than those in the control group, which would have been expected to favor the control group.