Team-based care approach to cholesterol management in diabetes mellitus: two-year cluster randomized controlled trial

Arch Intern Med. 2011 Sep 12;171(16):1480-6. doi: 10.1001/archinternmed.2011.417.

Abstract

Background: Creative, cost-effective interventions to improve the quality of care of chronic illnesses are needed. This study was designed to evaluate the impact of remote physician-pharmacist team-based care on cholesterol levels in patients with diabetes mellitus (DM).

Methods: This 2-year prospective, cluster randomized controlled trial was conducted within the Providence Primary Care Research Network in Oregon. Participants at least 18 years of age were identified by a diagnosis of DM. The intervention included remote physician-pharmacist team-based care focused on cholesterol management in DM. All clinicians in the study had access to the health information technology tool CareManager, which provided automated DM-related point-of-care prompts, a Web-based registry, and performance feedback with benchmarking. Study outcomes included the difference in low-density lipoprotein cholesterol (LDL-C) goal attainment, mean LDL-C, prescribed lipid-lowering therapy, and patient satisfaction between the intervention and control arms.

Results: A total of 6963 patients with DM cared for by 68 physicians in 9 clinics were evaluated. Patients in the intervention arm were more likely to achieve their target LDL-C levels compared with controls (78% vs 50%; P = .003). The mean LDL-C level was 12 mg/dL lower in the intervention arm compared with the control arm (P < .001). The rate of LDL-C testing was significantly higher in the intervention arm compared with the control arm. Patients in the intervention arm were also 15% more likely to receive a prescription for a lipid-lowering medication (P = .008). There was no significant difference in patient satisfaction between study arms (P = .15).

Conclusion: Remotely located physician-pharmacist team-based care resulted in significantly improved LDL-C levels and goal attainment among patients with DM.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anticholesteremic Agents / therapeutic use*
  • Cholesterol / blood*
  • Cholesterol, LDL / blood
  • Cholesterol, LDL / drug effects
  • Cooperative Behavior*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / drug therapy*
  • Female
  • Glycated Hemoglobin A / drug effects
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Oregon / epidemiology
  • Patient Compliance
  • Patient Satisfaction
  • Pharmacists
  • Physicians
  • Treatment Outcome

Substances

  • Anticholesteremic Agents
  • Cholesterol, LDL
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • Cholesterol