The impact of clinical pharmacy services integrated into medical homes on diabetes-related clinical outcomes

Ann Pharmacother. 2010 Dec;44(12):1877-86. doi: 10.1345/aph.1P380. Epub 2010 Nov 30.

Abstract

Background: Pharmacist services have expanded in the US health-care system from traditional roles to include comprehensive clinical services, but many studies lack comparison groups to evaluate outcomes of these clinical services.

Objective: To evaluate the clinical outcomes of uninsured or underinsured patients with type 2 diabetes who received care from pharmacists in local "safety net" clinic medical homes compared to outcomes of patients from clinics receiving usual care without the services of clinical pharmacists.

Methods: Pharmacists provided comprehensive pharmacy services in safety net clinic medical homes for uninsured patients in a major urban city. Referred patients had poor diabetes control (hemoglobin A(1c) [A1C] >9%). Pharmacists conducted comprehensive evaluations of medications, made adjustments, monitored adherence, and provided education and follow-up. Intervention patients were compared to similar patients who were receiving usual care but were not seen by a pharmacist. Outcomes evaluated were the change in A1C levels and achievement of treatment goals. Data were derived from chart reviews retrospectively. Multivariate least-squares and logistic regression models were used to estimate the impact of the intervention.

Results: Two hundred twenty-two intervention and 262 control patients were evaluated. Patients receiving care from pharmacists had adjusted A1C levels reduced by 1.38% relative to usual care, increasing the likelihood of achieving an A1C <7% by 3-fold (p < 0.001 for both estimates).

Conclusions: The integration of clinical pharmacy services into safety net medical homes was associated with improvement in clinical outcomes of patients with diabetes.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Pressure / physiology
  • Body Mass Index
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetes Mellitus, Type 2 / physiopathology
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Lipids / blood
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care / statistics & numerical data*
  • Patient-Centered Care / methods*
  • Pharmacy Service, Hospital / methods*

Substances

  • Glycated Hemoglobin A
  • Lipids
  • hemoglobin A1c protein, human