Impact of clinical pharmacist collaboration in patients beginning insulin pump therapy: a retrospective and cross-sectional analysis

Abstract

ObjectiveTo measure clinical and qualitative outcomes in patients with diabetes mellitus transitioning from intensive insulin therapy using multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) initiated and managed by clinical pharmacists under a collaborative practice agreement in a primary care setting without an endocrinologist.Research design and methodsThis study was a retrospective and cross-sectional analysis of data from an electronic medical record (EMR) and patient survey at a large primary care private practice. Patients with type 1 or type 2 diabetes who were ≥18 years old, started on CSII between 2007 and 2010, and had at least one follow-up visit post-CSII were analyzed. Mean HbA1c results were stratified across 3-month intervals post-CSII initiation and compared to pre-CSII levels. Body mass index (BMI), the number of diabetes-related clinic visits with the primary care physician (PCP), and non-insulin diabetes medication use was compared pre- and post-CSII initiation. Paper-based questionnaires were used to assess patient satisfaction with CSII vs MDI and pharmacist-led services.ResultsTwenty-five patients were included in the analysis. HbA1c decreased from 8.69 to 7.52% pre and post-CSII, respectively (p < 0.001). HbA1c also decreased across all 3-month intervals post-CSII. BMI decreased from 33.0 to 32.3 kg/m2 pre- and post-CSII, respectively (p = 0.085). Fewer diabetes-related PCP visits were completed post-CSII (5.09 vs 3.78 visits/year, p = 0.009), and less non-insulin diabetes medications were prescribed post-CSII (p < 0.001). Patients felt more comfortable controlling glycemic excursions and resultant insulin adjustments with CSII compared to MDI (p < 0.001).ConclusionsPharmacist-led CSII services appear to improve diabetes control in patients requiring intensive insulin therapy. Patients report greater comfort using CSII and strong confidence in the abilities of the pharmacist. Physician–pharmacist collaboration in the management of intensive insulin therapy in the primary care setting should be further explored.

The state of the science of interprofessional collaborative practice: A scoping review of the patient health-related outcomes based literature published between 2010 and 2018

“…Among the overlap outcomes displayed in Table 2 are: hospital length of stay, [20, 29] hospital readmission rates, [20, 29] direct cost of care, [20, 21, 31] A1c, [22, 29, 30, 33, 35, 36] blood pressure, [19, 23, 30, 33, 36, 37] and number of office visits. [28, 31, 32] While none of the studies reviewed detected any negative impacts of interprofessional collaborative care or interprofessional collaborative practice, not all findings favored a positive impact of interprofessional care or interprofessional practice.…”

“…[34] Two studies were retrospective cohort studies [23, 37] and one a prospective cohort study. [25] Two studies were cross-sectional, [28, 35] one sequential mixed methods, [33] one a case study,[27] and one a case/control study. [31] In addition to the wide variety of study designs employed, sample sizes ranged widely from one paper reporting two case studies to a sample size [27] of 322,408 patients.…”

“…The abstracted studies reported on research in six distinct settings: primary care, [19, 23–25, 28, 30–33, 35–37] hospital care, [19, 29, 34] specialty clinic care, [26, 38] nursing home care, [21] home health care, [27] and prison clinic (in and out patient care). [22] The most frequent study setting was primary care followed by hospital care as a distant second.…”

“…Fig 2 depicts the analysis process and Tables 3 and 4 describe the research outcomes and key study characteristics. The eight categories identified were: 1) Impact of interprofessional collaborative practice on chronic diseases with well-defined management measures [19, 22–24, 28–30, 33–35]; 2) Impact of interprofessional collaborative practice on specialty care outcomes with well-defined management measures [20, 26, 38]; 3) Impact of interprofessional collaborative practice on direct cost of care [20, 29, 31]; 4) Impact of interprofessional collaborative practice on prescribing practices and/or patient adherence [25, 32]; 5) Impact of interprofessional collaborative practice on dental care [27]; 6) interprofessional collaborative practice impact on falls [21]; 7) impact of interprofessional collaborative practice on health services utilization [31, 32]; 8) impact of interprofessional collaborative practice on patient satisfaction. [34]…”

“…The majority of the studies included in this review researched outcomes in primary care settings [19, 23–25, 28, 30–33, 35–37] and addressed clearly defined chronic diseases with well-defined management measures. [19, 22–24, 28–30, 33–36] In these instances the challenge of defining, operationalizing, and measuring patient health-related outcomes is minimized.…”