Impact of an Advanced Practice Pharmacist Type 2 Diabetes Management Program: A Pilot Study

Abstract

Background: The purpose of this study was to describe the impact of an Advanced Practice Pharmacist (APh) on lowering hemoglobin A1c (HbA1c) in patients with type 2 diabetes within a patient centered medical home (PCMH) and to classify the types of therapeutic decisions made by the APh.
 Methods: This was a retrospective study using data from electronic health records. The study evaluated a partnership between Chapman University School of Pharmacy and Providence St. Joseph Heritage Healthcare that provided diabetes management by an Advanced Practice Pharmacist in a PCMH under a collaborative practice agreement. Change in the HbA1c was the primary endpoint assessed in this study. The type of therapeutic decisions made by the APh were also evaluated. Descriptive analysis and Wilcoxon signed rank test were used to analyze data.
 Results: The study included 35 patients with diagnosis of type 2 diabetes mellitus managed by an APh from May 2017 to December 2017. Most of the patients were 60-79 years old (68.5%), 45.7% were female, and 45.7% were of Hispanic/Latino ethnicity. The average HbA1c was 8.8%±1.4% (range=6.0%-12.4%) and 7.5%±1.4% (range=5.5%-12.4%) at the initial and final APh visit, respectively (p<0.0001). Therapeutic decisions made by the APh included drug dose increase (35.5% of visits), drug added (16.4%), drug dose decrease (6.4%), drug switch (5.5%), and drug discontinuation (1.8%).
 Conclusion: The Advanced Practice Pharmacist’s interventions had a significant positive impact on lowering HbA1c in patients with type 2 diabetes mellitus in a PCMH. The most common therapeutic decisions made by the APh included drug dose increase and adding a new drug.
 
 Article Type: Pharmacy Practice

Implementation of the California advanced practice pharmacist and the continued disappointment of tiered licensure

“… 34 Similarly, Lewis and colleagues (2019) demonstrated that APhs significantly lowered hemoglobin A1c in patients with diabetes mellitus. 35 Neither study included a comparison group of non-APhs, limiting the ability to evaluate the outcomes of APhs relative to other pharmacists providing similar clinical services. In addition, other prior studies demonstrate that pharmacists without APh credentials have also had success in managing diabetes and anticoagulation clinics, thus it is not possible to conclude that the APh alone was responsible for the clinical outcomes achieved.…”

Pharmacist-Managed Diabetes Programs: Improving Treatment Adherence and Patient Outcomes

“…Embedded pharmacists may be physically located onsite five days a week or less often, depending on the size of the primary care office and the other responsibilities of the pharmacist in providing care via other disease management clinics or teaching requirements for those with faculty appointments at a college of pharmacy. 24,25 It is now common for embedded pharmacists to manage patients with diabetes through independent prescribing based on CDTM agreements, however there are other successful patient care models that have been described. These models include joint pharmacist-physician appointments in which both professionals evaluate the patient and develop a treatment plan at the point of care, pharmacist-patient appointments in which the pharmacist discusses each patient with the PCP to develop a treatment plan at the point of care, or pharmacist appointments where recommendations are provided via the EHR (electronic health record) to the PCP for implementation by the PCP or for implementation by the pharmacist following PCP authorization.…”

“…Thus, pharmacist-managed diabetes programs that include management of hypertension, hyperlipidemia, and nicotine cessation are commonly found within primary care settings. 24,26,30 Given the unique barriers that many PCPs face in caring for patients with diabetes along with the growing shortage of available PCPs, primary care is an ideal environment for pharmacists to assist with care delivery.…”

Effects of pharmacist-led interventions on glycaemic control, adherence, disease management and health-related quality of life in patients with type 2 diabetes: a protocol for a network meta-analysis

“…Pharmacists have been involved in chronic disease management, taking direct responsibility for patients’ disease states, medications and overall management to improve outcomes 24 25. Extensive global studies have demonstrated the effectiveness of pharmacist-based interventions on patients with diabetes, resulting in improved quality of care and clinical outcomes 23 26 28–30. In addition, several systematic reviews31–34 have identified various non-pharmacological pharmacist-led interventions, such as diabetes education,35–38 medication review,39 drug counselling/advice,40 41 lifestyle modification, self-care, peer support and behavioural intervention 42–44…”