Impact of Chronic Disease State Management by Clinical Pharmacists on Diabetes Outcomes: Interim Results of a Prospective Pilot Study

Abstract

Objective: To provide program methodology and outcomes data identifying the impact of clinical pharmacy services provided to patients with diabetes mellitus. Design: Prospective pilot study. Patients: Adult patients with diabetes mellitus identified by a member of the primary care team were referred to the pharmacist-led disease state management program, a patient-centered medication therapy management (MTM) program developed through university collaboration with a local Federally Qualified Health Center. Interventions: Pharmacist-delivered disease state management and medication therapy management across three or more face-to-face encounters over the course of six months. Main outcome measures: Clinical outcomes were followed for 6 months from the time of referral and enrollment into the program. The primary diabetes endpoint, glycosylated hemoglobin, and patient-reported experience with care were collected at baseline and the end of the study. Clinical pharmacists documented the content of clinical visits, including the number of visits per patient, duration of encounters, number and proportion of identified medication therapy problems, and the number and proportion of associated interventions to optimize pharmacotherapy. Results: Glycosylated hemoglobin was significantly reduced versus baseline at the 6-month assessment in both the intent-to-treat (−2.7%; P < 0.0001) and the per-protocol groups (−3.0%; P < 0.0001). Patient-reported satisfaction with care was higher for the pharmacists as compared to the primary care providers with significantly more patients rating the care received from the pharmacist as excellent ( P = 0.001). The pharmacists completed 158 visits, identifying and resolving an average of 7.7 medication therapy problems for each subject included in the analysis. Conclusion: In this model of MTM, the clinical pharmacists were able to identify and resolve interventions which subsequently resulted in statistically significant reductions observed in the primary diabetes endpoint and high levels of satisfaction with care.