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indication for PPI therapy and acid suppression therapy was discontinued (discontinue therapy group), 40 (31.0%) met the TennCare PA criteria for continuation of PPI therapy (PA group), and 71 (55.0%) did not meet the TennCare PA criteria and were stepped down to a H2-blocker (step-down group). At the 8-month follow-up, acid suppression therapy was assessed in 68 patients (21 patients were lost to follow-up): 13 patients (19.1%) had resumed PPI therapy; 38 (55.9%) were using an H2-blocker; and 17 (25.0%) were not using acid suppression therapy. Telephone interviews were completed for 45 of the 75 patients in the step-down and discontinue therapy groups who did not receive an escalation in acid suppression therapy after the initial intervention (i.e., who did not make a change from H2-blocker therapy to PPI therapy or from no acid suppression therapy to H2-blocker or PPI therapy). Twenty-eight patients (62.2%) reported symptoms once per week or less; 14 patients (31.1%) reported symptoms more often than once weekly. Symptom control was unable to be determined in 3 patients (6.7%) because of incomplete information obtained from the patient during the interview. CONCLUSIONS: After a proactive collaboration between physicians and clinical pharmacists in response to changes in TennCare formulary criteria for PPIs, more than one-half of patients were stepped down to H2-blocker therapy, and 14% were discontinued from acid suppression therapy. Among the step-down or therapy discontinuation patients for whom data were available at the 8-month follow-up, 81% were still using either an H2-blocker or no acid suppressing therapy at all, and 19% had resumed PPI use.

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Objective: To evaluate the effect of a medication assistance program and the addition of pharmacist management on clinical outcomes in patients with hypertension and diabetes through an Advanced Pharmaceutical Care program. Methods: This was a prospective quality improvement study on patients with hypertension and/or diabetes resistant to usual care. The primary outcomes were change in A1C, blood glucose, and blood pressure between 3 phases: usual care, free medications, and free medications plus pharmacist management. Secondary outcomes included achievement of A1C, blood glucose, and blood pressure goals as well as pharmacist interventions. Results: Seven patients were included in the study. The mean A1C decreased from 11.3% to 8.3% with free medications (p = 0.28) and from 8.3% to 6.4% with pharmacist management (p = 0.119). Mean blood pressure during usual care, free medications, and pharmacist intervention was 150/87 mm Hg, 148/85 mm Hg, and 125/78 mm Hg, respectively. After pharmacist management, 75% of patients with type 2 diabetes were able to achieve A1C and blood glucose goals, and 71% of patients with hypertension achieved blood pressure <130/80 mm Hg. Conclusions: The Advanced Pharmaceutical Care program allowed pharmacists to identify and overcome patient-specific barriers to care, provide individualized disease state education, and optimize medication management. Medication assistance led to improvements in A1C and blood pressure, but did not affect achievement of disease state goals. Pharmacist involvement in hypertension and diabetes care led to clinically significant reductions in blood pressure and A1C and enabled patients to reach guideline-recommended blood pressure and glycemic goals.