Diabetes: The Impact of Clinical Pharmacy Services Integrated into Medical Homes on Diabetes-Related Clinical Outcomes

Johnson, Kathleen A.; Chen, Steven; Cheng, I-Ning; Lou, Mimi; Gregerson, Paul; Blieden, Carla; Baron, Melvin; McCombs, Jeffrey S.

doi:10.1345/aph.1p380

Cited by 50 publications

(42 citation statements)

References 19 publications

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“…Previous studies have shown that patients who received pharmacist-managed care demonstrated improved A1c values. [7][8][9][10][11][12][13] Increased A1c is associated with increased costs per hospitalization, and these inpatient costs account for the major expenditure in health spending for patients with diabetes in the United States.…”

Section: ■■ Discussionmentioning

confidence: 99%

“…Minority populations, especially Hispanic patients, have a higher prevalence of diabetes, worse glycemic control, poor adherence, and more complications than non-Hispanic white patients with diabetes. 11 Previous studies have observed that Hispanics have a lower rate of diabetes-related hospitalizations. 11,19,20 Multiple factors contribute to this finding, such as cultural stigma associated with the hospital setting.…”

Section: Limitationsmentioning

confidence: 98%

“…11 Previous studies have observed that Hispanics have a lower rate of diabetes-related hospitalizations. 11,19,20 Multiple factors contribute to this finding, such as cultural stigma associated with the hospital setting. In this study's demographic, socioeconomic status could prohibit a patient from going to the hospital or ED even when needed.…”

Section: Limitationsmentioning

confidence: 98%

“…[6][7][8] Previous studies have shown that patients with diabetes who receive clinical pharmacist interventions demonstrate significantly improved hemoglobin A1c. [7][8][9][10][11][12][13] Furthermore, the data have shown that increased A1c is associated with increased costs per hospitalization. In fact, patients with a mean A1c of at least 10% or greater have significantly higher rates of diabetes-related hospital utilization, compared with patients with a mean A1c of < 7%.…”

Section: Patient Selectionmentioning

confidence: 99%

“…This study attempted to control for this unknown by requiring that a patient have 3 visits to be included in the study to determine the impact of clinical pharmacist intervention as shown in previous studies. 8,11 This study was conducted in a FQHC setting; thus, generalizability of the results is limited to underinsured and underserved populations. The majority of the study population was Hispanic (about 70%).…”

Section: Limitationsmentioning

confidence: 99%

See 4 more Smart Citations

Impact of a Clinical Pharmacy Program on Changes in Hemoglobin A1c, Diabetes-Related Hospitalizations, and Diabetes-Related Emergency Department Visits for Patients with Diabetes in an Underserved Population

Chung¹,

Rascati²,

Lopez³

et al. 2014

JMCP

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BACKGROUND: Diabetes mellitus is associated with substantial morbidity and mortality. With the rise in prevalence of diabetes, there has been an increased need for clinical pharmacy services focused on diabetes management in ambulatory clinics. However, more data IS needed to determine the overall impact that clinical pharmacists have on preventing diabetesrelated inpatient admissions and emergency department (ED) visits for patients with diabetes, especially in an underserved population.

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Section: ■■ Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 98%

Section: Limitationsmentioning

confidence: 98%

Section: Patient Selectionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

See 3 more Smart Citations

Impact of a Clinical Pharmacy Program on Changes in Hemoglobin A1c, Diabetes-Related Hospitalizations, and Diabetes-Related Emergency Department Visits for Patients with Diabetes in an Underserved Population

Chung¹,

Rascati²,

Lopez³

et al. 2014

JMCP

View full text Add to dashboard Cite

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Family physician perceptions of the role and value of the clinical pharmacist in the management of patients with type 2 diabetes

Harmes

Shih

Plegue

et al. 2019

J Am Coll Clin Pharm

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Purpose Clinical pharmacists can help primary care physicians (PCPs) manage medications for patients with poorly controlled type 2 diabetes. Studies have shown that clinical pharmacist involvement in care can improve outcomes such as glycosylated hemoglobin (A1C), blood pressure and lipid control, and decrease episodes of hypoglycemia. Despite these findings, some PCPs may be slow or disinclined to refer to clinical pharmacists when available. This study addressed PCP perceptions regarding referral to clinical pharmacists and endocrinologists for patients with poorly controlled type 2 diabetes. Methods Physicians from five family medicine sites were surveyed. Physicians were queried regarding their patterns for patient referral to endocrinologists and/or clinical pharmacists. Clinical contributions and importance of factors to consider when referring were compared between clinical pharmacists and endocrinologists using paired t tests. Results Fifty physicians responded to the survey, resulting in a response rate of 73.5%. The majority of PCPs indicated that they have referred to endocrinologists (89.5%) and clinical pharmacists (93.5%) for specialty care. PCPs tended to refer to clinical pharmacists sooner and at lower A1C values than to endocrinologists. PCPs also considered multiple medical comorbidities, history of noncompliance with medical recommendations, low reading ability or math skills, complex psychosocial situations, fear of needles, or difficulty affording medications or supplies to be more important when referring patients to clinical pharmacists than endocrinologists. Conclusion We hypothesized that referrals to a clinical pharmacist or endocrinologist are made with careful consideration of the patients' needs. PCPs reported increased utilization of clinical pharmacists for patients with nonmedical needs, indicating that extra time, education, and psychosocial support provided by the clinical pharmacist is highly valued.

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Dispensing pharmacy chains and direct anticoagulants: Potential associations with patient outcomes

Kozlowski,

Tworkoski,

Dharmarajan

et al. 2024

Pharmacoepidemiology and Drug

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PurposePharmacy chains can differ with respect to the characteristics of their patient populations as well as their nonprescription products, services, and practices, and thus may serve as a surrogate for potential unmeasured confounding in observational studies of prescription drugs. This study evaluates whether a single‐source drug can have different patient outcomes based on the dispensing pharmacy chain.MethodsSeparate analyses for two anticoagulant drugs, rivaroxaban and apixaban, were conducted using Medicare Fee‐for‐Service claims evaluating the association between dispensing pharmacy chain and outcomes of acute myocardial infarction, ischemic stroke, intracranial hemorrhage, gastrointestinal (GI) bleeding, all‐cause mortality, and major GI bleeding. Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates across pharmacy chain cohorts, and outcome association was assessed with a Cox Proportional Hazards model.ResultsWe observed no differences in outcomes across pharmacy chains for apixaban recipients. Rivaroxaban recipients from pharmacy chain C, however, had lower rates of GI bleeding (adjusted HR 0.83; 95% CI 0.69–1.00) and ischemic stroke (adjusted HR 0.57; 95% CI 0.38–0.87) as compared to chain A in primary analyses with a 3‐day grace period. The results moved closer to the null when 14‐ and 30‐day grace periods were implemented.ConclusionsThese results suggest that dispensing pharmacy chains may have the potential to act as a confounder of associations between drug exposure and outcome in some observational studies. Additional studies of potential confounding by pharmacy chain are needed. Further evaluation of potential pharmacy chain effects on safe use would be of value.

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Diabetes: The Impact of Clinical Pharmacy Services Integrated into Medical Homes on Diabetes-Related Clinical Outcomes

Abstract: The integration of clinical pharmacy services into safety net medical homes was associated with improvement in clinical outcomes of patients with diabetes.

Cited by 50 publications

References 19 publications

Impact of a Clinical Pharmacy Program on Changes in Hemoglobin A1c, Diabetes-Related Hospitalizations, and Diabetes-Related Emergency Department Visits for Patients with Diabetes in an Underserved Population

Impact of a Clinical Pharmacy Program on Changes in Hemoglobin A1c, Diabetes-Related Hospitalizations, and Diabetes-Related Emergency Department Visits for Patients with Diabetes in an Underserved Population

Family physician perceptions of the role and value of the clinical pharmacist in the management of patients with type 2 diabetes

Dispensing pharmacy chains and direct anticoagulants: Potential associations with patient outcomes

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