Effects of Pharmacist Chart Review and Pharmacist Interventions on Diabetes GAP Scores in the Rural Ambulatory Care Setting.

Abstract

Background: The Minnesota Community Measurement assesses health system performance for diabetes care based on five measures: blood glucose (A1c), blood pressure (BP), cholesterol (LDL), tobacco use, and aspirin use, aggregated and known as a "GAP score." Rural areas are negatively impacted by inadequate diabetes care. The positive impact of direct pharmacist patient care on diabetes management is well established, but research on indirect care is lacking. Objective: To assess the impact of pharmacist chart review on GAP scores in a rural primary care clinic. Methods: This was an evidence-based practice project conducted in a rural primary care clinic. Pre- and post-intervention GAP data were collected between January 1, 2023, and February 27, 2024. For each patient, pharmacists reviewed patient medical records for GAP score-related interventions. Reviews were completed at least one day prior to the patient's primary care appointment and sent to the appropriate providers via a secure messaging system. The primary study outcome was the frequency of patients experiencing a reduction in their GAP scores. Secondary outcomes included (1) the frequency of patients meeting the A1c, BP, LDL, tobacco use, and aspirin use GAP goals after one year, and (2) the frequency of patients transitioning from not meeting to meeting each of these GAP goals after one year. The primary and secondary outcomes were compared between the pharmacist and no-pharmacist intervention groups using Chi-square statistics. Results: Patients in the pharmacist intervention group were more likely to experience a reduction in GAP score (p<0.001), and met the A1c and tobacco usage GAP goal more often. Meeting the tobacco use GAP goal, however, was related more to the greater number of patients at goal in the intervention group at baseline. The treatment group was more likely to transition from not meeting to meeting the A1c, blood pressure, and aspirin GAP goals after one year. No significant changes were seen for the LDL GAP goal. Conclusions: Prospective pharmacist chart review may improve diabetes care in rural areas.