Pharmacist-managed diabetes care in a medically underserved population

Purpose: This study evaluated the impact on clinical outcomes of patients receiving pharmacist-managed diabetes care in a Federally Qualified Health Center.

Methods: This retrospective case series included all patients over the age of 18 years with diabetes meeting one of the following criteria during the year prior to referral:  A1C greater than 9 percent, systolic blood pressure (SBP) greater than 140 mmHg, diastolic blood pressure (DBP) greater than 90 mmHg, hospital admission or emergency department visit for a diabetes-related complication. Patients participating in the pharmacy outreach program received disease state management, patient education, and medication management. The pharmacist provided clinical services under a standing order set agreement with collaborating physicians and had autonomy to initiate, modify, or discontinue drug therapy. The pharmacy outreach program was supported by a grant funded by the Health Resources and Services Administration (HRSA), with a significant portion of grant dollars being spent on purchasing medications for uninsured patients. Primary outcomes analyzed were A1C, blood pressure, and low-density lipoprotein cholesterol (LDL-c). Baseline and end point data were analyzed for patients who attended at least one session with a clinical pharmacist during a 28 month period. Outcomes were assessed using general descriptive statistics and paired t-test.

Results: A total of 112 patients with a mean age of 48.7 years (standard deviation 11.5) met inclusion criteria and were included in the analysis (62.5 percent female). Of the primary outcomes targeted by the pharmacy outreach program, statistically significant reductions were realized for A1C, DBP, and LDL-c (1.1 percent, 2.4 mmHg, 12.7 mg/dL, respectively; p < 0.05). There was a non-statistically significant reduction in SBP of 2.1 mmHg (p = 0.22).

Conclusion: Patients with uncontrolled diabetes benefited from receiving pharmacist-delivered diabetes care. The significant improvements in A1C, blood pressure, and LDL-c support the role of a clinical pharmacist in a medically underserved population.