Support for this study was provided to Wilson by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number ULI TR001860. The content of this article is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health. The authors have nothing additional to disclose.

Two clinical pharmacy faculty members from a college of pharmacy provide comprehensive medication management in a rural family medicine clinic. The data was assessed for patients with diabetes managed by the pharmacists from 1 January 2017 through to 31 December 2019 to determine the service’s impact on patient outcomes. The primary outcome of this study is the change in the goal attainment rates of the three clinical goals of hemoglobin A1c, blood pressure, and appropriate statin therapy after pharmacist intervention. A total of 207 patients were included. At baseline, the patients had an average of 1.13 of the three goals met, improving to an average of 2.02 goals met after pharmacist intervention (p < 0.001). At baseline, 4.8% of the patients had met all three clinical goals, improving to 30.9% after pharmacist intervention (p < 0.001). There were significant improvements for the individual goal attainment rates of hemoglobin A1c (24.15% vs. 51.21%, p < 0.001), blood pressure (42.51% vs. 85.51%, p < 0.001), and appropriate statin therapy (45.89% vs. 65.70%, p < 0.001). This data adds to the evidence supporting the integration of clinical pharmacists into primary care clinics to improve patient outcomes related to diabetes.

The American Diabetes Association recommends that patients with type II diabetes and atherosclerotic cardiovascular disease be prescribed an SGLT-2 inhibitor or GLP-1 agonist for cardioprotective benefit. This project assessed the use of these medications in this patient population in a rural clinic by measuring prescribing rates of SGLT-2/GLP-1 therapy before and after pharmacist interventions. Of the 60 patients identified at baseline, 39.39% (13/33) managed by a pharmacist were prescribed SGLT-2/GLP-1 therapy compared to the 14.81% (4/27) who had not seen a pharmacist (p = 0.025). Of the 43 patients that were not on SGLT-2/GLP-1 therapy at baseline, 13 were lost to follow-up and 13 had contraindications. For the 17 remaining patients, pharmacists recommended initiating SGLT-2/GLP-1 therapy and were able to successfully initiate therapy for 9 patients (52.94%). Pharmacist interventions improved the prescription rates from a baseline of 36.17% (17/47) to 55.3% (26/47) (p = 0.002), with SGLT-2/GLP-1 therapy contraindicated in 27.66% (13/47) of patients. This suggests that patients managed by a pharmacist have medication regimens that were optimized at a greater rate and pharmacists can have a positive impact on the appropriate medication usage in this population.

No abstract

Continuous glucose monitors (CGMs) are helpful tools in managing diabetes, and it is important that primary care providers (PCPs) receive adequate training on how to use them. There are various on-demand lectures about CGMs that are available for clinicians, but these programs lack a hands-on component. In a rural Family Medicine residency clinic, two clinical pharmacists created a training program for PCPs which included an educational module, a hands-on experience wearing an intermittently-scanned CGM for 2 weeks, and a debriefing module. This study describes and evaluates this training program. The investigators created a questionnaire aimed to measure PCPs confidence and knowledge of CGMs. PCPs were given the identical questionnaire at baseline, after the educational module (midpoint), and after the debriefing module (final). Descriptive statistical analysis was performed to assess differences in confidence and knowledge levels throughout the program. A total of 21 PCPs completed the program, including 13 medical residents, six physician faculty, and two nurse practitioners. On a scale from 1 to 10, PCP’s rated their average baseline knowledge of CGMs at 3.8. This increased to 5.3 at midpoint, and 7.9 at final. For the knowledge-based portion of the questionnaire, PCPs scored an average of 20.35% at baseline, and this increased to 75.32% at midpoint, and 90.48% at final. After completion of the training program, all 21 participants either agreed or strongly agreed that having the opportunity to wear a CGM provided them with more confidence in working with patients with CGMs, compared to a lecture-based training program alone. This study demonstrates that a training program including a hands-on experiential component can improve PCPs confidence and knowledge levels regarding CGMs. Disclosure J.Prudencio: None. M.Kim: None. C.Chan: None. Funding Abbott Medical Education (2182022)