Impact on outcomes of patients seen by ambulatory care clinical pharmacists for diabetes management in a large public health care system

Purpose: To evaluate clinical outcomes and costs in patients seen by ambulatory care clinical pharmacy specialists (CPS) for diabetes management in a large urban county health care system.  Seven ambulatory care CPS manage diabetes mellitus at their respective practice sites under a collaborative practice agreement.  Outcomes and cost are evaluated annually to justify services offered.

Methods: Patients seen by a CPS for diabetes management between January 1, 2009 and December 31, 2011 were included in the yearly analyses.  Diabetes-related outcomes and costs, including hemoglobin A1c (HbA1c), blood pressure (BP), lipids, medications, and other standards of care measures, were assessed at the end of 2009, 2010, and 2011 for patients discharged from CPS services.

Results: A total of 586 patients were included in the annual assessments.  At each yearly assessment, patients demonstrated improvements in glycemic control with absolute decreases in HbA1c averaging 2.4% (p<0.001 for each year).  Lowering of systolic BP, diastolic BP, total cholesterol, triglycerides, low density lipoprotein cholesterol, and non-high density lipoprotein cholesterol were also observed.  Rates of achievements in various standards of care measures increased.  Patients’ medication adherence rates increased by at least 65%.  Patients’ average number of medications did not increase by more than 8.5%, while the cost of 30-day supply of medications increased by no more than 6.8%. 

Conclusions: Annual assessments of the outcomes of patients seen by ambulatory care CPS for diabetes management demonstrated positive impact in HbA1c reduction, as well as other clinical outcomes including BP and lipids.  Adherence to standards of care measures improved.  CPS increased patient medication adherence while maintaining costs of medications for the health system.  Through interventions such as medications changes, patient education, and drug therapy monitoring, ambulatory care CPS have positively impacted the patients referred for diabetes management on a consistent basis for 3 consecutive years.