Analysis of Glycemic Control of a Pharmacist-Led Medication Management Program in Patients with Type 2 Diabetes

Ko, John J.; Lu, Jackie; Rascati, Karen L.; Stock, Eileen M.; Juan, Joyce; Suh, Kangho; Kim, Yoona; Tabor, Patricia A.; Godley, Paul J.

doi:10.18553/jmcp.2016.22.1.32

Cited by 17 publications

(35 citation statements)

References 19 publications

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“…One study used a case-control study design and had a moderate risk of bias [ 86 ]. 14 were pre-post studies; one had a high risk of bias [ 87 ], 11 had medium risk of bias [ 88 – 98 ], and two had low risk of bias [ 99 , 100 ]. Six studies were record/chart reviews: two were assessed to have low risk of bias [ 101 , 102 ] and four had medium risk of bias [ 103 – 106 ].…”

Section: Resultsmentioning

confidence: 99%

“…Such studies tended to consider context within the narrative of diabetes control in their region. 32 studies described the national context in which the study took place [ 25 , 27 , 31 , 33 , 42 , 43 , 48 , 50 , 51 , 54 , 59 – 62 , 66 , 67 , 74 , 80 – 82 , 85 , 86 , 91 , 92 , 96 , 98 , 100 , 104 , 111 , 112 , 115 , 116 ]. This typically involved descriptive statistics to indicate the magnitude and urgency of diabetes as a national challenge, highlighting incidence or prevalence rates and cost burden.…”

Section: Resultsmentioning

confidence: 99%

“…A pre-post study from the United States found that an intervention with pharmacists adjusting medications, evaluating therapeutic needs, and developing care plans recorded significantly lower mean HbA1c readings compared with the control group after one and two years. The two-year average decrease in HbA1c was greater for the intervention group compared to the control (p = 0.009) [ 100 ].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies considered interdependencies between healthcare financing and service delivery [ 32 , 55 , 100 , 102 , 114 ]. They pointed to high costs of associated services required for diabetes care and control, particularly with regard to the cost of prescription medication.…”

Section: Resultsmentioning

confidence: 99%

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Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review

et al. 2018

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BackgroundType 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control.Methods and findingsA protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals.ConclusionsThis review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review

et al. 2018

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“…Other studies have shown positive associations between pharmacist-led management program and the clinical outcomes considered in this study. 13 – 16 A meta-analysis of 15 randomized controlled trials also noted significant improvements in cardiovascular risk factors related to pharmacist-managed care. 17 However, there are clear differences between these previous studies and the current study including differences in settings (eg, Veterans Affairs and community health center vs integrated health system), study design (eg, randomized clinical trial vs observational study), lower individual study sample sizes, and the differences in the design and maturity of the disease management programs.…”

Section: Discussionmentioning

confidence: 99%

Impact of a pharmacist-led diabetes management on outcomes, utilization, and cost

Maeng¹,

Graham²,

Bogart³

et al. 2018

CEOR

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PurposePharmacist-led medication therapy disease management (MTDM) has shown improvement in clinical outcomes in patients with certain chronic diseases. However, only limited data demonstrating the impact on health care utilization and cost of care are available. This study seeks to evaluate the impact of a pharmacist-led MTDM program on clinical surrogate outcomes, care utilization, and cost of care among patients with diabetes mellitus.MethodsA retrospective cohort study was conducted by utilizing electronic health records and insurance claims data. Patients were identified between February 2011 and December 2014. Data were collected from Geisinger, a large integrated health care system located in Pennsylvania and southern New Jersey. A total of 5,500 patients with diabetes mellitus were identified; 2,750 were enrolled in MTDM and were 1-to-1 propensity score-matched to a comparison cohort not enrolled in a pharmacist-led MTDM program.ResultsThere were no differences between groups in composite HbA1c, blood pressure, or low-density lipoprotein cholesterol goal attainment at 12 months (12% vs 12%, P=0.53). HbA1c goal was reached more frequently among patients without MTDM compared to those at 12 months (57% vs 51%, P<0.0001). There were no significant differences between the two cohorts in the attainment of blood pressure or low-density lipoprotein cholesterol goals at 12 months. MTDM was associated with reduced all-cause hospitalization rate (−19.6%; P=0.02) as well as increased primary care physician visits (18.5%; P<0.001) and lower average per-member-per-month medical cost (−13%, P=0.027).ConclusionDespite the lack of impact on the clinical surrogate outcomes, MTDM was associated with lower cost of care and fewer hospitalizations, possibly facilitated by increased monitoring (ie, higher primary care utilization).

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Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

Talon

Pérez

Yan

et al. 2019

J Am Coll Clin Pharm

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Studies evaluating the cost-effectiveness of clinical pharmacy services (CPS) are needed to justify implementation and reimbursement. Through a systematic review, we describe services provided by pharmacists and their economic outcomes. We conducted a literature search of published studies in PubMed, Ovid, and Embase from January 2011 through December 2017. Manuscripts evaluating a CPS with patient-level economic outcomes and conducted in the United States were included. Study risks of bias were classified by study design characteristics. Economic evaluations were classified according to the presence of a comparator, and cost and outcome measures included. The quality of full economic evaluations was assessed using the Quality of Health Economic Studies (QHES) instrument. Descriptive statistics were used to summarize CPS characteristics. After screening, 115 studies wereincluded. Type of service provided included general pharmacotherapy (41%), disease management (30%), and targeted drug program (17%). Settings included hospital (34%), ambulatory care (28%), and community pharmacy (17%). Study designs were considered high risk of bias (use of a historical control group or no control group) in 69% of cases while 25% were medium risk of bias (non-randomized with a concurrent control group) and 6% were low risk of bias (randomized experimental or multigroup interrupted time series). Economic evaluation types were descriptive studies that measured cost and/or outcomes of a CPS (55%), comparative studies that measured cost or outcomes of a CPS and a comparator (37%), and full evaluations that measured cost and outcomes of a CPS and a comparator (8%). Among nine full evaluations, the median (range) QHES score was 74 (59-95) and four reported the CPS as being more effective at a lower cost. Few full economic evaluations were conducted, but supported the cost-effectiveness of CPS. Use of a comparator group and measurement of economic inputs and outcomes would strengthen the body of evidence. K E Y W O R D Scost-benefit analysis, health services research, pharmacoeconomics, pharmacy

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Analysis of Glycemic Control of a Pharmacist-Led Medication Management Program in Patients with Type 2 Diabetes

Abstract: A pharmacist-led diabetes MMP, combined with a diabetes drug copay waiver, was effective in significantly reducing A1c over a 2-year period for type 2 diabetic patients in this regional health plan.

Cited by 17 publications

References 19 publications

Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review

Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review

Impact of a pharmacist-led diabetes management on outcomes, utilization, and cost

Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

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