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Purpose: Describe a pharmacist-led, collaborative drug therapy management (CDTM) program. Identify clinical and economic outcomes in CDTM patients treated with insulin.
Methods: Two University of Utah Community Clinics implemented a CDTM program in 2008 and 2009. Under a collaborative practice agreement, community clinic pharmacists manage drug therapy and provide medication and disease counseling to patients referred to CDTM by clinic physicians; most are referred for insulin management. To identify CDTM-related outcomes, we compared HbA1c, healthcare utilization, and cost changes after CDTM enrollment in patients with uncontrolled T2DM (HbA1c ≥7.0%) treated with insulin in 2009-2010 to patients with uncontrolled T2DM treated with insulin under usual care at non-CDTM clinics. Change in HbA1c was identified at 6-months (-90 to +180 days) as were changes in utilization and costs 6-month pre-index to 6-months post-index date. Multivariate regression analyses were used to estimate adjusted changes in HbA1c and overall costs controlling for baseline HbA1c and other confounders.
Results: A total of 95 DCCM patients (mean age 60.4 years; 59% female) and 46 comparison patients (mean age 61.2 years [p>.05]; 48% female [p>.05]) were included. Identification of comparison patients was challenging due to lower insulin use and lack of HbA1c data to assess outcomes. Baseline HbA1c was higher for CDTM (10.3%) than comparison patients (9.1%; p<.001). CDTM patients had a 1.97% greater reduction in HbA1c, which remained significant after adjusting for confounders (coefficient: -1.31; 95% CI -1.76, -0.86). Comparison patients had a greater increase in sub-specialty clinic visits during the follow-up period than CDTM patients (0.5 vs. -0.05 visit change; p=0.01); the adjusted difference in overall costs from pre- to post index date did not differ between groups.
Conclusion: This pharmacist-led CDTM program improved glycemic control without increasing overall costs in patients with uncontrolled T2DM treated with insulin in the community setting.