Objective To identify factors associated with years of medication adherence and to examine the relationship between years of adherence and health care utilization. Methods This retrospective analysis used administrative data from adult patients with diabetes enrolled in health plan in Hawaii for four years (n= 23,450 patients). Ordered logistic regression was used to examine factors related to years of medication adherence for three types of medications (anti-diabetic, antihypertensive, lipid-lowering). Multivariable logistic regression and negative binomial regression were used to examine relationship between years of adherence and health care utilization (hospitalizations and emergency department visits). Key Findings Adherence to any of the medications for all four years was significantly associated with lower odds of a hospitalization or emergency department visit in the third year. The magnitude of reduction in utilization was greater for adherence to anti-diabetic and lipid-lowering medications, at 31% compared to 22% for antihypertensives. The 9% of patients who were adherent to all three types of medications for all four years showed a reduction of 53%. Conclusions Improvement is needed in medication adherence across all three types of medication. Interventions may need to target younger adults, women, patients with congestive heart failure, Filipinos and Native Hawaiians.

Objective To examine racial/ethnic disparities in medication adherence between Asian and Pacific Islander Americans and Whites. Methods This retrospective data analysis included diabetes patients enrolled in a Hawaiian health plan (N = 43,445). For anti-diabetic, lipid-lowering, and anti-hypertensive medications, quantile regression was estimated at 25th, 50th, and 75th quantiles to examine the association with race and ethnicity, controlling for other patient characteristics. Results Consistently, Filipinos, Native Hawaiians, and other Pacific Islanders were significantly less adherent than Whites. The greatest disparities were found for other Pacific Islanders using lipid-lowering medications, with adjusted differences in medication adherence, with reductions relative to Whites of as much as 19% for lipid-lowering medications for the 25th quantile of adherence. Conclusion Whereas the large sample size undoubtedly contributed to the statistical significance, the large magnitude of the disparities, particularly for Filipinos, Native Hawaiians, and other Pacific Islanders, suggests that these are meaningful differences that need to be addressed. The largest disparities were found at the lowest quantile suggests that they may be occurring among the most vulnerable populations with potentially poor access to care.

Objective. To compare second-and third-year pharmacy students' competence, attitudes, and selfconfidence in providing diabetes care before and after completing a hand-on diabetes training program and to determine if the program had an impact on students' attitude and self-confidence based on their year in the curriculum. Design. The program included classroom lectures and hands-on learning sessions in 5 facets of diabetes care. Pre-and post-test instruments measured students' competence, attitudes, and confidence in diabetes care. Assessment. Students' competence and the mean overall confidence score significantly improved after completing the program, while mean overall attitude score did not. Third-year students had significantly higher confidence scores than did second-year students on both pre-and post-program tests. No significant difference was found for attitude scores between second-and third-year students. Conclusion. The hands-on learning program was an effective approach to training pharmacy students in diabetes care, improving both their competence and confidence.

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Purpose Diabetes impacts a significant population in the United States, with uncontrolled diabetes leading to serious adverse health effects and substantial cost to the healthcare system. Diabetes management by clinical pharmacy services (CPS) demonstrating positive clinical outcomes has been well-established in the primary care setting. However, there is little data evaluating the impact of CPS in specialty clinics such as endocrinology, which may provide additional opportunities for pharmacists to improve outcomes in a complex patient population. The purpose of this study is to describe the implementation of CPS in an ambulatory endocrinology clinic and to evaluate the impact of pharmacist care on diabetes management. Methods This was a retrospective, pre- post- descriptive study. Patients were enrolled into the study during a 6-month period and followed for a minimum of 6 months. The primary endpoint was mean change in hemoglobin A1c (HbA1c) between the pre- and post- pharmacist intervention phase. Secondary endpoints included blood pressure outcomes, statin appropriateness, rates of hospital and Emergency Department (ED) admissions due to severe hyper- or hypo- glycemia, and rates of retinal screening exams. Results A total of 101 patients were included in the study population. The mean baseline HbA1c was 9.11% and at six months 8.27%, with mean change of 0.84% (p-value <0.01). Descriptive statistics showed that blood pressure control, as well as statin and retinal screening rates, were high at baseline, with CPS making limited interventions in these areas. Conclusion This study demonstrated that pharmacist interventions in diabetes care is associated with improved HbA1c for a complex patient population in an endocrinology clinic.