A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes

Nye, Ann Marie

doi:10.18043/ncm.78.3.183

Cited by 8 publications

(9 citation statements)

References 2 publications

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“…A study conducted in a rural area of North Carolina assessed a clinical pharmacist's role on telehealth team, and noted a significant reduction in weight, A1c and LDL within the 12 months of the pharmacy intervention. 6 However, when outcomes of the patients included in the telehealth group were compared to those managed in a clinic setting at an academic medical center, the change in % A1c from baseline was non-inferior and did not demonstrate statistical or clinical significance. 6 A similar observation of lack of statistical significance was noted in our study.…”

Section: Discussionmentioning

confidence: 92%

Evaluation of Outcomes of a Pharmacist-Run, Outpatient Insulin Titration Telepharmacy Service

Stockton

Deas

2019

Innov Pharm

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Purpose: Diabetes can pose a significant disease burden for patients and is often challenging to manage in underserved patient populations with limited access to care. A pilot study was conducted to determine the impact of a pharmacist-run insulin titration service, provided via telephone, to patients of a local ambulatory care clinic with a large medically, underserved patient population. The pilot service was implemented in Spring 2018 at Cooper Green Mercy Health Services (CGMHS) and was provided by an affiliate clinical pharmacist who is also on faculty at Samford University’s McWhorter School of Pharmacy. Patients who received care within the CGMHS diabetes clinic were eligible for referral to the service. The service was provided via a collaborative practice agreement. The purpose of this study was to evaluate and compare clinical outcomes of patients who received the telepharmacy service versus the standard of care. Standard of care was defined as patients whose insulin therapy was managed solely by the primary care provider or by a diabetes clinic provider, without clinical pharmacist involvement in the patient’s care. Methods: This manuscript presents the results of a retrospective chart review conducted at CGMHS of patients, ages 19 or older, with a documented diagnosis of type 1 or type 2 diabetes who received care during the timeframe of February 2018 through September 2018 – the initial months of the pilot telepharmacy service. Results: Sixty-seven patients met criteria for inclusion in the analysis - 16 managed in the telepharmacy service, 28 in diabetes clinic, and 23 in primary care. Patients in the telepharmacy group achieved a mean A1c change of -1.14% compared with -0.88% in the diabetes clinic group and +0.21% in the primary care group (p=0.061). In the telepharmacy group, 43.75% of patients experienced at least a 1% reduction in A1c from baseline compared with 35.71% in the diabetes clinic group and 26.09% in primary care (p=0.51). Conclusion: Integration of the clinical pharmacy services for insulin titration positively affected patients’ degree of glucose control. Although no statistically significant reductions in A1c were observed in this study, it should be noted that pharmacist intervention was associated with a modestly higher percent A1c reduction from baseline vs. the standard of care. The pharmacist-run service produced changes in clinical outcomes that numerically exceeded those experienced by patients receiving specialty care, in the diabetes clinic, and within primary care. As a result of this study, the pilot program has remained in effect and is in the initial stages of expansion of the consult service to eligible primary care patients. Article Type: Original Research

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Section: Discussionmentioning

confidence: 92%

Evaluation of Outcomes of a Pharmacist-Run, Outpatient Insulin Titration Telepharmacy Service

Stockton

Deas

2019

Innov Pharm

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“…These effects are more evident when prescription abilities are ascribed to the pharmacist (an activity not allowed by Italian law). With regard to telemedicine in pharmacy, most experiences reported in the literature refer to the telemonitoring of blood glucose levels [17] in rural and isolated areas [18][19][20]. However, point-of-care (PoC) equipment and remote-reporting systems (electrocardiogram, ocular fundus, etc.)…”

Section: Discussionmentioning

confidence: 99%

A New Case Manager for Diabetic Patients: A Pilot Observational Study of the Role of Community Pharmacists and Pharmacy Services in the Case Management of Diabetic Patients

Regina¹,

Pandolfi²,

Stabile³

et al. 2020

Pharmacy

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The adherence of type 2 diabetes mellitus (DM2) patients with an individual care plan (ICP) is often not satisfactory, nor does it allow for a significant improvement in outcome, because of poor accessibility to services, poor integration of pathway articulations, poor reconciliation with the patient’s life, or the lack of a constant reference person. The purpose of this study was to evaluate the contribution of community pharmacists and pharmacy services in improving adherence with periodic controls in DM2. The study was conducted at a rural pharmacy. A sample of 40 patients was calculated with respect to a historical cohort and subsequently enrolled. Clinical and personal data were collected in an electronic case report form. Pharmacists acting as a case manager followed patients carrying out their ICP developed by an attending physician. Some of the activities foreseen by the ICP, such as electrocardiogram, fundus examination, and self-analysis of blood and urine, were carried out directly in the pharmacy by the pharmacist through the use of telemedicine services and point of care units. Activities that could not be performed in the pharmacy were booked by the pharmacist at the accredited units. Examination results were electronically reported by the pharmacist to the attending physician. The primary endpoint was the variation in patient adherence with the ICP compared to a historical cohort. Secondary endpoints were variation in waiting time for the examinations, mean percentage change in glycated hemoglobin (HbA1c) and low-density lipoprotein (LDL) cholesterol levels and blood pressure, impact on healthcare-related costs, and perceived quality of care. Adherence to the ICP significantly increased. Waiting times were reduced and clinical outcomes improved with conceivable effects on costs. Patients appreciated the easier access to services. Community pharmacists and pharmacy services represent ideal actors and context that, integrated in the care network, can really favor ICP adherence and obtain daily morbidity reduction and cost savings through proper disease control and an early diagnosis of complications.

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“…There appears to be clear benefit in improving safety and mitigating medication errors in the outpatient care arena. [1][2][3][4][5][6][7][8][9] Some articles discuss tele-emergency pharmacy care for inpatients within intensive care and behavioural health units, 10 but our literature search provided no documented cases of a clinical pharmacist working in teleemergency medicine providing real-time, synchronous care to a remote, rural ED.…”

Section: Discussionmentioning

confidence: 99%

Ethylene glycol and methanol ingestion cared for by tele-emergency pharmacy and tele-emergency medicine

et al. 2018

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A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes

Cited by 8 publications

References 2 publications

Evaluation of Outcomes of a Pharmacist-Run, Outpatient Insulin Titration Telepharmacy Service

Evaluation of Outcomes of a Pharmacist-Run, Outpatient Insulin Titration Telepharmacy Service

A New Case Manager for Diabetic Patients: A Pilot Observational Study of the Role of Community Pharmacists and Pharmacy Services in the Case Management of Diabetic Patients

Ethylene glycol and methanol ingestion cared for by tele-emergency pharmacy and tele-emergency medicine

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