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Purpose: Evaluate clinical and economic outcomes in university–owned community clinic patients with uncontrolled type 2 diabetes (T2DM) referred to pharmacist-coordinated, diabetes chronic care management (DCCM).
Methods: This retrospective cohort study based on medical record and administrative data from 2008-2010 compared patients with uncontrolled T2DM (HbA1c ≥7.0%) referred to DCCM in 2009 or 2010 to a cohort of patients with uncontrolled T2DM treated by a clinic not supporting DCCM. Index date was DCCM enrollment date or for comparison patients, HbA1c reading after 12 months of EMR activity after 1/1/2008. Changes in HbA1c from baseline to 6-months (-90 to +180 days) and goal attainment (<7.0% vs. ≥7.0%) were identified, as were changes in utilization and costs from 6-months pre- to 6-months post-index. Multivariate regression analyses were used to calculate the likelihood of attaining HbA1c goal and estimate adjusted changes in HbA1c, healthcare use, and costs.
Results: A total of 119 DCCM and 199 comparison patients were included. Mean (sd) age was 58.7 (13.1) vs. 60.9 (12.9) years (p>.05) for DCCM and comparison patients, respectively; 55.3% vs. 42.7% were female (p=0.03). Baseline HbA1c was higher for DCCM (10.2% [1.8]) than comparison patients (8.4% [1.5]; p<.001). After adjusting for baseline HbA1c and other confounders, the DCCM group had a 1.3% greater reduction in HbA1c than comparison patients (coefficent: -1.31; 95% CI -1.76, -0.86) and were 2.6 times more likely to attain HbA1c goal. DCCM patients had an increase in the mean number of community clinic visits during the follow-up period than comparison patients (1.5 vs. -0.3 visit change; p=0.009). When adjusting for confounders, the overall cost differences from pre- to post index date did not differ.
Conclusion: This pharmacist-led DCCM program was associated with improved glycemic control and an increase in community clinic visits without increasing costs in patients with uncontrolled T2DM.