A Retrospective Cohort Analysis of the Clinical Effectiveness of a Physician‐Pharmacist Collaborative Drug Therapy Management Diabetes Clinic

Abstract

The glycemic control of patients with diabetes in a physician-supervised, pharmacist-managed primary care clinic was compared with that of patients receiving standard care in the same health care system. We retrospectively analyzed the glycemic control of 87 men with type 1 or type 2 diabetes whose diabetes-related drug therapy was managed by clinical pharmacists compared with a control group of 85 similar patients whose care was not augmented by clinical pharmacists. Primary outcomes were differences in fasting blood glucose (FBG) and glycosylated hemoglobin (A1C) levels between groups. Secondary outcomes were relative risk (RR) for achieving an A1C of 7% or below, frequency of diabetes-related scheduled and unscheduled clinic visits, and frequency of hypoglycemic events. The study group had 864 clinic visits and the control group had 712 between October 1997 and June 2000. No statistical differences were noted in FBG or A1C between groups. The RR of achieving an A1C of 7% or below was significantly higher in the study cohort (RR 5.19, 95% confidence interval [CI] 2.62-10.26). The frequency of hypoglycemic events did not differ between groups. The mean +/- SD frequency of unscheduled diabetes-related clinic visits/patient/year was higher in the control group (1.33 +/- 3.74) than in the study group (0.11 +/- 0.46, p = 0.003). Pharmacist-managed diabetes care was effective in improving glycemic control and was not associated with an increased risk for hypoglycemic events or unscheduled diabetes-related clinic visits.

Randomized Controlled Trial of Clinical Pharmacy Management of Patients with Type 2 Diabetes in an Outpatient Diabetes Clinic in Jordan

“…54 Research has indicated that adherence to medication in type 2 diabetes is poor and is considered as one of the main barriers to the benefit of optimal diabetes care and a major cause of unnecessary hospitalization. 55,56 Consistent with findings from earlier research, 28 patients who received the clinical pharmacy service in the present study demonstrated significantly better self-reported medication adherence compared with the control group patients.…”

Effect of a Pharmaceutical Care Program on Vascular Risk Factors in Type 2 Diabetes

“…We had a pharmacist working relatively independently of hospital/primary care diabetes facilities, but, as an extension of previous studies (15,16), the strategies we used could be implemented by a similar person located with physicians, diabetes educators, and other health professionals in a clinic. Community pharmacists should also be able to adapt aspects of our PC model to their circumstances (12,13).…”

“…Two studies demonstrated some benefits of pharmacist involvement in the diabetes health care team (15,16), but they did not consider vascular risk factors other than glycemia, and in one (16), clinical pharmacist input was only part of the intervention. It has been suggested that rigorously designed PC studies addressing all aspects of diabetes care are of paramount importance (17).…”

Impact of Pharmacist Intervention on Diabetes Patients in an Ambulatory Setting

“…[3][4][5][6][7] The current study assessed A1C changes resulting from seeing a pharmacist and then compared them to changes that result from usual care to find out whether pharmacist care results in any additional benefit.…”