Implementation and Evaluation of a Pharmacist-led Glucagon-like Peptide-1 Receptor Agonist Titration Service in Two Primary Care Clinics.

Abstract

Background: People with type 2 diabetes are increasingly prescribed glucagon-like peptide-1 receptor agonists (GLP-1 RAs) which require frequent follow-up for tolerability and dose optimization. To prevent clinical inertia, ambulatory care pharmacists are well-positioned to provide titration services to reduce prescriber burden.

Objectives: The objective of this study was to describe the implementation and evaluation of a pharmacist-led GLP-1 RA titration service.

Practice description: The two clinics included in this study are part of a community-based health system serving northern Illinois.

Practice innovation: Included clinics are staffed by an ambulatory care pharmacist working under a delegation protocol. Initial encounters address medication accessibility and education. Follow-up visits evaluate tolerability, blood glucose control, and dose optimization.

Evaluation methods: The primary endpoint was the absolute change in hemoglobin A1c (A1c) from baseline to 3-6 months post-titration. Paired t-tests were used for statistical comparisons.

Results: From September 2022 to May 2023, 120 patients met inclusion criteria; 8 patients stopped therapy. Mean baseline A1c was reduced by -1.8% (P<0.001) at 3-6 months post-titration. Average change in weight was -8.1 kg (N=107) (P<0.001). The number of diabetic medications decreased from an average of 2.5 to 2.1 medications. The percentage of patients meeting Healthcare Effectiveness Data and Information Set (HEDIS) measures for diabetes after pharmacist intervention were 97.3% for blood pressure under 140/90 mm Hg, 95.5% for A1c under 8%, 100% for serum creatinine tested in last 12 months, and 90.2% for urine microalbumin/ creatine ratio (UACR) tested in last 12 months. The average patient required 6.5 encounters and 91 total pharmacist minutes to achieve GLP-1 RA optimization. Approximately 0.1 full-time equivalents of pharmacist coverage were required over 13 months to manage 120 patients.

Conclusions: Ambulatory care pharmacists can effectively optimize GLP-1 RAs to improve clinical outcomes, meet quality-based metrics, and reduce prescriber burden.