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Purpose: To determine how oral hypoglycemic medication management and patient self-management impact A1c control in a pharmacist managed population versus control group.
Methods: This two year study consists of a prospective intervention group and a retrospective, matched control group. Patients were matched one-to-one based on A1c, age, gender, time of enrollment, and Charlson co-morbidity index. The intervention consists of monthly visits with the pharmacist, co-payment waivers for selected diabetes medications and supplies, assessment of medications and review of patient education. Patients in the control group receive standard medical care and do not receive the co-payment waiver. Outcomes include the change in A1c, number of oral medications, number of dosage titrations per patient, maximum dosage achieved for individual oral agents, number of new diabetes medications initiated in each patient, persistence based on refill patterns and test strip utilization.
Results: A total of 138 patients (69 in each group) completed two years. The average number of oral hypoglycemic medications per patient at base line was found to be 2.13 in the intervention group and 1.75 in the control group. The change in the number of medications from baseline to endpoint was not significant (p=0.5). The intervention group received significantly more dosage titrations than the control group (86 vs. 57, p<0.05). Initiation of new oral hypoglycemic medication occurred more frequently in the intervention group (41 vs. 30). Medication possession ratio improved in the intervention group and declined in the control group (+0.030 vs. -0.093, p<0.001).
Conclusion: Patients managed by pharmacist experienced an improved A1c compared to control group. More aggressive dose titrations may partially explain changes in A1c. There was an improvement in adherence as measured by MPR in pts in the MMP group. Further data analysis will be conducted and presented.