Clinical pharmacist intervention and the proportion of diabetes patients attaining prevention objectives in a multispecialty medical group.

摘要

BACKGROUND: Clinical practice recommendations from American Diabetes Association (ADA) include specific prevention goals intended to reduce the risk of diabetic complications. The Healthy People 2010 (HP2010) initiative, updated to Healthy People 2020, proposes similar objectives for improvement of clinical measures and outcomes in patients with diabetes. Clinical pharmacists are gaining an increasing role in providing diabetes management services, including collaborative practice in medical groups. OBJECTIVE: To compare the rates of attainment of diabetes prevention goals described by the ADA 2009 guidelines and the HP2010 initiative for patients receiving clinical pharmacist interventions in a collaborative practice diabetes clinic versus patients receiving usual care. METHODS: The setting is a primary care clinic affiliated with a 140-physician multispecialty medical group in the upper Midwest. Diabetes patients were identified from electronic medical records by ICD-9-CM diagnosis codes 250.00 through 250.99 for dates of service in the 12-month period from January 1, 2007, through December 31, 2007. Study subjects had to be aged 18 years or older and have at least 2 visits to a primary care physician (PCP) or the pharmacist-managed diabetes clinic during 2007. Descriptive statistics and chi-square analysis were utilized. RESULTS: Of 7,068 patients at least 18 years of age with at least 1 diabetes diagnosis code for a medical encounter in 2007, 1,298 (18.4%) had a least 1 visit in the pharmacist-managed diabetes clinic, and 321 patients (4.5%) had 2 or more visits. These 321 patients were compared with 321 patients stratified by gender and randomly selected from 3,022 patients who had at least 2 visits with a PCP and no visits in the pharmacist-managed diabetes clinic in 2007. Nine of the 14 HP2010 objectives (64.3%) were attained in the intervention group compared with 7 of 14 (50.0%) in the usual care group. For patients with hypertension at baseline, 44.6% (120/269) in the intervention group versus 48.0% (123/256) in the usual care group achieved goal blood pressure (P = 0.430). The low-density lipoprotein (LDLC) goal ( less than 100 milligrams per deciliter) was achieved in 76.0% of patients in the intervention group (244/321) versus 59.2% (190/321) in usual care (P less than 0.001). Fewer patients in the intervention group achieved hemoglobin A1c less than 7% (50.8%, n =163/321) compared with usual care (71.0%, n = 228/321, P less than 0.001). The proportions of patients with influenza and pneumococcal vaccinations were higher in the intervention group versus the usual care group for 3 of 4 comparisons by age, but neither group met the target goals. CONCLUSIONS: Patients who were seen by the clinical pharmacists met more of the preventive care objectives recommended by the ADA 2009 and HP2010 initiatives; however, more patients in usual care met the A1c goal compared with pharmacist-managed patients. The absence of baseline values for A1c, blood pressure, and LDL-C prevented longitudinal assessment of the effects of this clinical pharmacist intervention.