Impact of a Pharmacist Led Comprehensive Medication Management Program in Patients with Diabetes in a Rural Health Care Setting
by Taylor DeBoer, PharmD, Rachel Kopfhamer, PharmD, Christina Kellar, PharmD, Joshua Lee, PharmD, BCACP, Katherine Nichols, PharmD, BCACP, Sara Griesbach, PharmD, BCPS, BCACP
"Background: Pharmacists providing care in rural areas help increase healthcare access for patients. Further integration of pharmacists into the healthcare team helps patients meet their treatment goals and reduce financial burdens. The Marshfield Clinic Health System (MCHS) Diabetes Care Management program aims to provide high-quality, patient-centered care to enrolled patients through comprehensive medication management (CMM) services. Continued analysis of the Diabetes Care Management program is crucial for understanding the impact pharmacists have on patients with diabetes and determining the feasibility of expanding this service system wide.
Methods: As a quality improvement project, this initiative was exempted
by the Institutional Review Board. The primary outcome of this study
was to analyze the change in hemoglobin A1c (HbA1c) in patients with uncontrolled type 2 diabetes contacted by a pharmacist. A pharmacist provided CMM services and performed a medication reconciliation telephonically with the patient. Pharmacists identified medication-related problems and offered recommendations to the provider. Pharmacists performed follow-up telephone calls to assess each patient’s tolerance for medication therapy and additional opportunities to optimize the patient’s medication regimen. Secondary outcomes included evaluation of change in blood pressure, change in low-density lipoprotein (LDL) cholesterol, change in hospitalizations, and proportion of patients that reached HbA1c < 8%.
Results: There were 310 unique enrollments who completed at least one follow-up visit with a pharmacist and were included in the final statistical analysis. There was a statistically significant decrease in average change in HbA1c from baseline to most recent follow-up visits for patients enrolled in the MCHS Diabetes Care Management Program, which was -1.0% (95% CI: -1.2 to -0.8, p-value: <0.001).
Conclusions: The inclusion of a pharmacist on an interdisciplinary health care team showed a reduction in HbA1c values and other laboratory values that are important for patients with type 2 diabetes. As demonstrated in this quality improvement project, pharmacists are an integral component of a patient's health care team. Through comprehensive medication management services provided by pharmacists, patients diabetes management improved, decreasing their risk of health complications and medical costs."
Keywords: Glycated Hemoglobin, Pharmacists, Diabetes Mellitus, Cholesterol, LDL, Medication Therapy Management, Blood Pressure, Ethics Committees, Research, Feasibility Studies, Financial Stress, Follow-Up Studies, Goals, Medication Reconciliation, Quality Improvement, Patient-Centered Care, Patient Care Team, Health Services Accessibility, Hospitalization, Telephone
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2024 May/June Table of Contents
"Background: Pharmacists providing care in rural areas help increase healthcare access for patients. Further integration of pharmacists into the healthcare team helps patients meet their treatment goals and reduce financial burdens. The Marshfield Clinic Health System (MCHS) Diabetes Care Management program aims to provide high-quality, patient-centered care to enrolled patients through comprehensive medication management (CMM) services. Continued analysis of the Diabetes Care Management program is crucial for understanding the impact pharmacists have on patients with diabetes and determining the feasibility of expanding this service system wide.
Methods: As a quality improvement project, this initiative was exempted
by the Institutional Review Board. The primary outcome of this study
was to analyze the change in hemoglobin A1c (HbA1c) in patients with uncontrolled type 2 diabetes contacted by a pharmacist. A pharmacist provided CMM services and performed a medication reconciliation telephonically with the patient. Pharmacists identified medication-related problems and offered recommendations to the provider. Pharmacists performed follow-up telephone calls to assess each patient’s tolerance for medication therapy and additional opportunities to optimize the patient’s medication regimen. Secondary outcomes included evaluation of change in blood pressure, change in low-density lipoprotein (LDL) cholesterol, change in hospitalizations, and proportion of patients that reached HbA1c < 8%.
Results: There were 310 unique enrollments who completed at least one follow-up visit with a pharmacist and were included in the final statistical analysis. There was a statistically significant decrease in average change in HbA1c from baseline to most recent follow-up visits for patients enrolled in the MCHS Diabetes Care Management Program, which was -1.0% (95% CI: -1.2 to -0.8, p-value: <0.001).
Conclusions: The inclusion of a pharmacist on an interdisciplinary health care team showed a reduction in HbA1c values and other laboratory values that are important for patients with type 2 diabetes. As demonstrated in this quality improvement project, pharmacists are an integral component of a patient's health care team. Through comprehensive medication management services provided by pharmacists, patients diabetes management improved, decreasing their risk of health complications and medical costs."
Keywords: Glycated Hemoglobin, Pharmacists, Diabetes Mellitus, Cholesterol, LDL, Medication Therapy Management, Blood Pressure, Ethics Committees, Research, Feasibility Studies, Financial Stress, Follow-Up Studies, Goals, Medication Reconciliation, Quality Improvement, Patient-Centered Care, Patient Care Team, Health Services Accessibility, Hospitalization, Telephone
Download PDF
2024 May/June Table of Contents