Implementation of a pharmacist-driven continuous glucose monitoring program within an American Indian/Alaska Native community

IF 1.3 Q4 PHARMACOLOGY & PHARMACY
DeAnne L. Udby Pharm.D., Dena K. Smith Pharm.D., Nicholas Cushman Pharm.D., Mary Vue B.S., David Reyes-Gastelum M.S., Austin Klapperich Pharm.D., Tori Ohman Pharm.D., Alyssa J. Hromika Pharm.D., Emily R. Mackler Pharm.D.
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引用次数: 0

Abstract

Introduction

Ambulatory care pharmacists can help overcome systemic barriers in diabetes management for American Indians and Alaska Natives (AI/AN) by facilitating the adoption and management of continuous glucose monitoring (CGM) technology. Despite the proven clinical benefits of CGM, its use in AI/AN populations remains limited and underexplored. The aim of this study was to evaluate the impact of a pharmacist-driven CGM program on glycemic control in AI/AN patients with diabetes and to characterize the implementation of the intervention in clinical practice.

Methods

This is a retrospective, single-center, observational study using data from a pharmacist-driven CGM program at a rural, Indian Health Service, ambulatory health center in the midwestern United States serving AI/AN individuals. The study included a pilot phase with a matched-cohort design and a subsequent post-pilot implementation. Participants in the intervention group received comprehensive CGM education and management from clinical pharmacists, with follow-up visits for 6 months. The primary outcome was the change in hemoglobin A1c (HbA1c) levels, analyzed using multilevel linear regression models.

Results

In the pilot phase, 79% of the intervention group achieved a 1% reduction in HbA1c at 6 months, with an average reduction of 2%. The control group showed no significant change (p = 0.032 for CGM vs. control arms). Post-pilot implementation maintained these improvements, with a mean HbA1c reduction of 1.5% in a larger patient cohort (p < 0.001 for pre- vs. post-CGM implementation). Patient confidence in managing diabetes and satisfaction with care also increased.

Conclusion

Implementing a pharmacist-driven CGM program in AI/AN communities can address health care disparities and improve diabetes outcomes. This model holds promise for broader application in managing chronic diseases in underserved populations, highlighting the critical role of pharmacists in interdisciplinary health care teams. Further research should focus on long-term outcomes and economic impacts to support the widespread adoption of this approach.

在美国印第安人/阿拉斯加土著社区实施药剂师驱动的连续血糖监测项目
门诊药师可以通过促进连续血糖监测(CGM)技术的采用和管理,帮助克服美国印第安人和阿拉斯加原住民(AI/AN)糖尿病管理中的系统性障碍。尽管已证实CGM的临床益处,但其在AI/AN人群中的应用仍然有限且未得到充分探索。本研究的目的是评估药剂师驱动的CGM项目对AI/AN糖尿病患者血糖控制的影响,并描述该干预措施在临床实践中的实施情况。方法:这是一项回顾性、单中心、观察性研究,使用来自药剂师驱动的CGM项目的数据,该项目在美国中西部的一个农村、印度卫生服务、流动卫生中心开展,为AI/AN患者提供服务。该研究包括一个具有匹配队列设计的试点阶段和随后的试点后实施。干预组接受临床药师全面的CGM教育和管理,随访6个月。主要终点是血红蛋白A1c (HbA1c)水平的变化,使用多水平线性回归模型进行分析。在试验阶段,干预组中79%的患者在6个月时HbA1c降低1%,平均降低2%。对照组与对照组相比无显著变化(p = 0.032)。试点实施后保持了这些改善,在更大的患者队列中,HbA1c平均降低1.5%(实施cgm前与实施cgm后相比p <; 0.001)。患者对糖尿病管理的信心和对护理的满意度也有所提高。结论在AI/AN社区实施药剂师驱动的CGM项目可以解决医疗保健差异并改善糖尿病预后。该模型有望在服务不足人群的慢性病管理中得到更广泛的应用,突出了药剂师在跨学科卫生保健团队中的关键作用。进一步的研究应侧重于长期结果和经济影响,以支持这种方法的广泛采用。
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CiteScore
2.70
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