PHARMACIST-MANAGED DIABETES SERVICE IN A RURAL FREE CLINIC Katherine R. Gerrald, PharmD 1,2,3 ;...
3
PHARMACIST-MANAGED DIABETES SERVICE IN A RURAL FREE CLINIC Katherine R. Gerrald, PharmD 1,2,3 ; Julie M. Sease, PharmD 1,2 ; Meg Franklin, PharmD, PhD 1 1. Presbyterian College School of Pharmacy 2. Good Shepherd Free Medical Clinic 3. St. Luke’s Free Medical Clinic Background References Methods Results Conclusion • Diabetes management provided by pharmacists has been shown to favorably impact hemoglobin A1c (A1c) levels, blood pressure, and lipid control in health-care systems, community health centers, primary care clinics, and large urban free clinics 1-8 • A1c reductions have been used to quantify cost-avoidance 9 • Whether or not a similar program could be effective in a small rural free clinic remains to be seen Objective • 95 patients continuously enrolled in a newly established pharmacist service were followed over a 24 month period • Patient population: o ≥18 years of age o Qualified for free care based on income and insurance status o Diagnosis of T2DM • Visits with pharmacist included: o Education about T2DM and lifestyle modifications o Assessment & management of drug therapy for T2DM and co-morbid conditions according to collaborative agreement with medical director • Clinical impact measured by: o Change in A1c, blood pressure, and lipid levels o Pharmacists interventions • Economic impact calculated based on cost savings per 1% decrease in A1c American College of Clinical Pharmacy Annual Meeting, October 17, 2011 • Pharmacist management of patients with T2DM has the potential to significantly impact clinical outcomes and improve costs of care for patients in underserved rural areas 1.Davidson MB, Karlan VJ, and Hair TL. Effect of a pharmacist-managed diabetes care program in a free medical clinic. Am J Med Qual 2000;15:137-142. 2.Scott DM, Boyd ST, Stephan M, Augustine SC, and Reardon TP. Outcomes of pharmacist- managed diabetes care services in a community health center. Am J Health Syst Pharm 2006;63:2116-2122. 3.Jameson JP and Baty PJ. Pharmacist collaborative management of poorly controlled diabetes mellitus: a randomized controlled trial. Am J Mang Care 2010;16:250-255. 4.Rothman RL, Malone R, Bryant B, et al. A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. Am J Med 2005;118:276-284. 5.Odegard PS, Goo A, Hummel J, Williams KL, and Gray SL. Caring for poorly controlled diabetes mellitus: a randomized pharmacist intervention. Ann Pharmacother 2005;39:433- 440. 6.Choe HM, Mitovich S, Dubay D, Hayward RA, Krein SL, and Vijan S. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial. Am J Manag Care 2005;11:253-256. 7.Ragucci KR, Fermo JD, Wessell AM, and Chumney ECG. Effectiveness of pharmacist- administered diabetes mellitus education and management services. Pharmacotherapy 2005;25:1809-1816. 8.Cioffi ST, Caron MF, Kalus JS, Hill P, and Buckley TE. Glycosylated hemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic. Ann Pharmacotherapy 2004;28:771-775. 9.Wagner E, Sandhu N, Newton K, et al. Effect of improved glycemic control in health care costs and utilization. JAMA 2001;285:182- • To determine the impact of pharmacist education, monitoring, and management of patients with type 2 diabetes mellitus (T2DM) enrolled in a free clinic that serves a rural indigent population Total Patients (N=95) Gender Male Female 45 (47%) 42 (53%) Age (mean) 51 yrs Ethnicity Black Caucasian Hispanic 49 (52%) 42 (44%) 4 (4%) Prior Medications Antiplatelet ACE/ARB Insulin Metformin Sulfonylurea Statin TZD 27 (28%) 63 (66%) 36 (38%) 76 (80%) 39 (41%) 49 (52%) 7 (7%) Past Medical History CAD HTN Dyslipidemia Amputation Retinopathy 12 (13%) 77 (81%) 71 (75%) 3 (3%) 6( 6%) Smoker 34 (35%) Baseline (mean ± SD) Follow-up (mean ± SD) P value A1c (%) n=95 10.7 ± 2.4 8.1 ± 1.9 <0.000 1 SBP (mmHg) n=95 130.9 ± 21.7 123.59 ± 16.17 0.0011 DBP (mmHg) n=95 77.9 ± 11 74.11 ± 9.88 0.0015 LDL (mg/dL) n=82 103.5 ± 33.2 81.45 ± 25.77 <0.000 1 TG (mg/dL) n=82 251.7 ± 258.7 156.48 ± 87.92 0.0001 HDL (mg/dL) n=82 41.7 ± 14.4 41.48 ± 12.48 0.7504 Table 1. Baseline Demographics Table 2. Clinical Outcomes Economic Impact • Given an expected savings of $1,118 per 1% decrease in A1c level, the average savings per patient was $2,940 • This equates to a total savings potential of $279,332 for patients enrolled in the clinic Clinical Impact • By 24 months, 35.7% of patients achieved an A1c goal of ≤7% (P<0.0001) • Significant numbers of patients reached SBP goal ≤130 mmHg (P=0.016), DBP goal ≤ 80 mmHg (P=0.007), LDL ≤100 mg/dL (P<0.0001), or triglycerides ≤150 mg/dL (P=0.0009) Clinical Interventions • 1,159 pharmacist interventions were documented during the study period • Most interventions were comprehensive including disease state education, change(s) in drug therapy, and medication counseling • 77.6% of medication interventions were changes in current drug therapy • Increasing medication dose was the most common medication modification documented (50.4%) followed by adding an additional medication (28.4%) • A total of 73 referrals for eye exams were placed during the 24 months • Smoking cessation counseling was provided during 112 patient visits 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% Adjusted New Starts 103 54 54 76 5 41 106 77 282 303 6 52 Baseline Follow-up 0.0 2.0 4.0 6.0 8.0 10.0 12.0 10.7 8.1 $279,332 savings Figure 1. Medication Classes Adjusted Figure 2. Savings Based Upon A1c Improvement Contact: Kate Gerrald, PharmD, BCPS ([email protected]) Disclosure: None of the authors have any conflicts of interest to disclose.
-
Upload
johanne-dole -
Category
Documents
-
view
222 -
download
1
Transcript of PHARMACIST-MANAGED DIABETES SERVICE IN A RURAL FREE CLINIC Katherine R. Gerrald, PharmD 1,2,3 ;...
PHARMACIST-MANAGED DIABETES SERVICE IN A RURAL FREE CLINICKatherine R. Gerrald, PharmD1,2,3; Julie M. Sease, PharmD1,2; Meg Franklin, PharmD, PhD1
1. Presbyterian College School of Pharmacy 2. Good Shepherd Free Medical Clinic 3. St. Luke’s Free Medical Clinic
Background
References
Methods
Results Conclusion• Diabetes management provided by pharmacists
has been shown to favorably impact hemoglobin A1c (A1c) levels, blood pressure, and lipid control in health-care systems, community health centers, primary care clinics, and large urban free clinics1-8
• A1c reductions have been used to quantify cost-avoidance9
• Whether or not a similar program could be effective in a small rural free clinic remains to be seen
Objective
• 95 patients continuously enrolled in a newly established pharmacist service were followed over a 24 month period
• Patient population: o ≥18 years of ageo Qualified for free care based on income
and insurance statuso Diagnosis of T2DM
• Visits with pharmacist included:o Education about T2DM and lifestyle
modificationso Assessment & management of drug
therapy for T2DM and co-morbid conditions according to collaborative agreement with medical director
• Clinical impact measured by:o Change in A1c, blood pressure, and lipid
levelso Pharmacists interventions
• Economic impact calculated based on cost savings per 1% decrease in A1c
American College of Clinical Pharmacy Annual Meeting, October 17, 2011
• Pharmacist management of patients with T2DM has the potential to significantly impact clinical outcomes and improve costs of care for patients in underserved rural areas
1. Davidson MB, Karlan VJ, and Hair TL. Effect of a pharmacist-managed diabetes care program in a free medical clinic. Am J Med Qual 2000;15:137-142.
2. Scott DM, Boyd ST, Stephan M, Augustine SC, and Reardon TP. Outcomes of pharmacist-managed diabetes care services in a community health center. Am J Health Syst Pharm 2006;63:2116-2122.
3. Jameson JP and Baty PJ. Pharmacist collaborative management of poorly controlled diabetes mellitus: a randomized controlled trial. Am J Mang Care 2010;16:250-255.
4. Rothman RL, Malone R, Bryant B, et al. A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. Am J Med 2005;118:276-284.
5. Odegard PS, Goo A, Hummel J, Williams KL, and Gray SL. Caring for poorly controlled diabetes mellitus: a randomized pharmacist intervention. Ann Pharmacother 2005;39:433-440.
6. Choe HM, Mitovich S, Dubay D, Hayward RA, Krein SL, and Vijan S. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial. Am J Manag Care 2005;11:253-256.
7. Ragucci KR, Fermo JD, Wessell AM, and Chumney ECG. Effectiveness of pharmacist-administered diabetes mellitus education and management services. Pharmacotherapy 2005;25:1809-1816.
8. Cioffi ST, Caron MF, Kalus JS, Hill P, and Buckley TE. Glycosylated hemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic. Ann Pharmacotherapy 2004;28:771-775.
9. Wagner E, Sandhu N, Newton K, et al. Effect of improved glycemic control in health care costs and utilization. JAMA 2001;285:182-189.
• To determine the impact of pharmacist education, monitoring, and management of patients with type 2 diabetes mellitus (T2DM) enrolled in a free clinic that serves a rural indigent population
Total Patients (N=95)
Gender Male Female
45 (47%)42 (53%)
Age (mean) 51 yrs
Ethnicity Black Caucasian Hispanic
49 (52%)42 (44%)
4 (4%)
Prior Medications Antiplatelet ACE/ARB Insulin Metformin Sulfonylurea Statin TZD
27 (28%)63 (66%)36 (38%)76 (80%)39 (41%)49 (52%)
7 (7%)
Past Medical History CAD HTN Dyslipidemia Amputation Retinopathy
12 (13%)77 (81%)71 (75%)
3 (3%)6( 6%)
Smoker 34 (35%)
Baseline(mean ± SD)
Follow-up(mean ± SD)
P value
A1c (%)n=95
10.7 ± 2.4 8.1 ± 1.9 <0.0001
SBP (mmHg)n=95
130.9 ± 21.7 123.59 ± 16.17 0.0011
DBP (mmHg)n=95
77.9 ± 11 74.11 ± 9.88 0.0015
LDL (mg/dL)n=82
103.5 ± 33.2 81.45 ± 25.77 <0.0001
TG (mg/dL)n=82
251.7 ± 258.7 156.48 ± 87.92 0.0001
HDL (mg/dL)n=82
41.7 ± 14.4 41.48 ± 12.48 0.7504
Table 1. Baseline Demographics
Table 2. Clinical Outcomes
Economic Impact• Given an expected savings of $1,118 per 1% decrease in A1c
level, the average savings per patient was $2,940• This equates to a total savings potential of $279,332 for
patients enrolled in the clinic
Clinical Impact• By 24 months, 35.7% of patients achieved an A1c
goal of ≤7% (P<0.0001)• Significant numbers of patients reached SBP goal
≤130 mmHg (P=0.016), DBP goal ≤ 80 mmHg (P=0.007), LDL ≤100 mg/dL (P<0.0001), or triglycerides ≤150 mg/dL (P=0.0009)
Clinical Interventions• 1,159 pharmacist interventions were documented
during the study period • Most interventions were comprehensive including
disease state education, change(s) in drug therapy, and medication counseling
• 77.6% of medication interventions were changes in current drug therapy
• Increasing medication dose was the most common medication modification documented (50.4%) followed by adding an additional medication (28.4%)
• A total of 73 referrals for eye exams were placed during the 24 months
• Smoking cessation counseling was provided during 112 patient visits
Oral Antidiab
etic
Antihyperlip
idemic
Antiplatelet
Antihyperte
nsive
Insulin
Other
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
AdjustedNew Starts
103
54 5476
5
41
106
77
282 303
6
52
Baseline Follow-up0.0
2.0
4.0
6.0
8.0
10.0
12.0
10.7
8.1
$279,332 savings
Figure 1. Medication Classes Adjusted
Figure 2. Savings Based Upon A1c Improvement
Contact: Kate Gerrald, PharmD, BCPS ([email protected])Disclosure: None of the authors have any conflicts of interest to disclose.
TITLE OF PRESENTATION/POSTER GOES HERENames of the people presenting go here, along with professional titles
Names of collaborating institutions go here
Background
References
Methods
Results Conclusion• Insert background information here• Here• Here• Here
Objective
• Insert Methods here• Here• Here• Here
Insert Conference Name Here, Date/Year
• Insert Conclusion Information Here
1. Insert Reference List here
2. Here
3. Here
4. Here
5. Here
6. Here
7. Here
8. Here
9. Here
10. Here
11. Here
12. Here
13. Here
14. Here
15. Here
16. Here
• Insert Objective Information here• Here• Here• Here
Information(Values)
Example Ex1 Ex2
45 (47%)42 (53%)
Example 51 yrs
Demographics Black Caucasian Hispanic
49 (52%)42 (44%)
4 (4%)
Information Exampletol
27 (28%)
Demographics Information
12 (13%)
Examples 34 (35%)
Information(values)
Information(values)
Info(values)
ExampleTiny example
10.7 ± 2.4 8.1 ± 1.9 <0.0001
ExampleTiny example
130.9 ± 21.7 123.59 ± 16.17 0.0011
ExampleTiny example
77.9 ± 11 74.11 ± 9.88 0.0015
Table 1. Name of Table 1
Table 2. Name of Table 2
Graph Example 1• Information about the Graph 2• Information about Graph 2
Interesting Findings• Information here
• Here
More Findings• List of more findings
• List of more findings
• More findings
• More findings
• More findings
• More findings
• More findings
• More findings
• More findings Oral Antidiab
etic
Antihyperlip
idemic
Antiplatelet
Antihyperte
nsive
Insulin
Other
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
AdjustedNew Starts
103
54 5476
5
41
106
77
282 303
6
52
Baseline Follow-up0.0
2.0
4.0
6.0
8.0
10.0
12.0
10.7
8.1
$279,332 savings
Figure 1. Name of Graph 2
Figure 2. Name of Graph 1
Contact: Contact Information here
Disclosure: None of the authors have any conflicts of interest to disclose.
Optional Conference logo here, or delete
TITLE OF PRESENTATION/POSTER GOES HERENames of the people presenting go here, along with professional titles
Names of collaborating institutions go here
Background
References
Methods
Results Conclusion• Insert background information here• Here• Here• Here
Objective
• Insert Methods here• Here• Here• Here
Insert Conference Name Here, Date/Year
• Insert Conclusion Information Here
1. Insert Reference List here
2. Here
3. Here
4. Here
5. Here
6. Here
7. Here
8. Here
9. Here
10. Here
11. Here
12. Here
13. Here
14. Here
15. Here
16. Here
• Insert Objective Information here• Here• Here• Here
Information(Values)
Example Ex1 Ex2
45 (47%)42 (53%)
Example 51 yrs
Demographics Black Caucasian Hispanic
49 (52%)42 (44%)
4 (4%)
Information Example
27 (28%)
Demographics Information
12 (13%)
Examples 34 (35%)
Information(values)
Information(values)
Info(values)
ExampleTiny example
10.7 ± 2.4 8.1 ± 1.9 <0.0001
ExampleTiny example
130.9 ± 21.7 123.59 ± 16.17 0.0011
ExampleTiny example
77.9 ± 11 74.11 ± 9.88 0.0015
Table 1. Name of Table 1
Table 2. Name of Table 2
Graph Example 1• Information about the Graph 2• Information about Graph 2
Interesting Findings• Information here
• Here
More Findings• List of more findings
• List of more findings
• More findings
• More findings
• More findings
• More findings
• More findings
• More findings
• More findings Oral Antidiab
etic
Antihyperlip
idemic
Antiplatelet
Antihyperte
nsive
Insulin
Other
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
AdjustedNew Starts
103
54 5476
5
41
106
77
282 303
6
52
Baseline Follow-up0.0
2.0
4.0
6.0
8.0
10.0
12.0
10.7
8.1
$279,332 savings
Figure 1. Name of Graph 2
Figure 2. Name of Graph 1
Contact: Contact Information here
Disclosure: None of the authors have any conflicts of interest to disclose.
Optional Conference logo here, or delete
