Impact Of Pharmacy Ambulatory Care Services In Managing Patients With Diabetes In An Indigent Population Clinic: A

Purpose: The purpose of this study was to assess the benefit of pharmacist ambulatory care services in the management of patients with uncontrolled diabetes in an indigent population clinic. Methods: Patients with uncontrolled diabetes were referred to the pharmacist diabetes clinic (PDC) for diabetes management. The pharmacist collected, recorded, and assessed baseline and follow-up subjective and objective information during each appointment. Patients included for data collection were those referred to the PDC with uncontrolled diabetes despite previous health care provider management. Patients were excluded if another specialist was required to intervene in the care of the patient’s diabetes or if the patient did not follow-up at least once. The primary outcome was change in hemoglobin A1c (HgbA1c). The secondary outcomes were changes in fasting blood glucose (FBG), random blood glucose (RBG), number of patients experiencing hypoglycemic events, number of patients experiencing nocturia, the implementation of daily foot inspections, and medications prescribed prior to and after pharmacist intervention. Results: A paired t-test was conducted for objective lab values to assess the statistical significance of change prior to and after pharmacist intervention. Patients’ HgbA1c averaged 12.1% before and 9.8% after pharmacist intervention (95% CI, 0.656 to 3.884; p=0.0112). FBG levels averaged 198 mg/dL before and 147 mg/dL after pharmacist intervention (95% CI, -12.23 to 168.23; p=0.0841). RBG levels averaged 234 mg/dL before and 199 mg/dL after pharmacist intervention (95% CI, 2.58 to 202.14; p=0.0453). Four patients reported an average of 2 monthly hypoglycemic events before and 3 patients reported an average of 1 monthly hypoglycemic event after pharmacist intervention. Three patients before and 10 patients after pharmacist intervention checked their feet daily. Twelve patients before and 8 patients after pharmacist intervention experienced nocturia. Medication modifications decreased adverse events, intolerance, and hypoglycemia. Conclusion: Clinical pharmacist diabetes management provided a decrease in HgbA1c by 2.3%, FBG by 51 mg/dL, and RBG by 35 mg/ dL. Statistical significance was found with the change in HgbA1c and RBG values. Number of patients experiencing hypoglycemia and nocturia decreased after pharmacist intervention while the number of patients who checked their feet daily increased after pharmacist intervention. Medication regimens decreased adverse events, intolerance, and hypoglycemic events. Citation: Latif JM (2020) Impact of Pharmacy Ambulatory Care Services in Managing Patients with Diabetes in an Indigent Population Clinic: A Case Review Study. J Gastroenterol Hepatology Res 5: 029.