Impact of Diabetes Care by Pharmacists as Part of Health Care Team in Ambulatory Settings: A Systematic Review and Meta-analysis

Fazel, Maryam; Bagalagel, Alaa; Lee, Jeannie K.; Martin, Jennifer; Slack, Marion

doi:10.1177/1060028017711454

Cited by 80 publications

(79 citation statements)

References 64 publications

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“…Overall, the 2‐year improvement in HbA1C was comparable with other CHW‐driven intervention studies, yet slightly less than other pharmacist‐collaborator models, which average a 1.1% decrease in HbA1C over 6–12 months . In comparison, the improvement in HbA1C over the first 12 months was 0.87% in this study.…”

Section: Discussionsupporting

confidence: 70%

“…Current health care delivery approaches for these vulnerable groups, particularly African American and Hispanic/Latino, are inadequate . A range of interventions with primary care providers, nurses, dieticians, pharmacists, and community health workers (CHWs) designed to improve glucose and cardiovascular control in diverse patient populations have resulted in mixed results . However, the most effective interventions studied to date consist of multidisciplinary teams providing a range of components.…”

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confidence: 99%

“…Clinical pharmacists provide expertise in medication‐related issues (e.g., drug interactions and cost), encourage adherence, provide patient education, and adjust therapy in collaboration with providers, resulting in improvements in a range of clinical outcomes . A recent meta‐analysis of diabetes outcomes with clinical pharmacy support identified 35 studies and found a moderate effect representing a mean reduction in hemoglobin A 1c (HbA1C) of 1.1% (95% confidence interval [CI] 0.88–1.27) with pharmacist care in the ambulatory setting . Pharmacist involvement varied from providing patient education to medication adjustment via prescriptive authority.…”

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confidence: 99%

“…2 A range of interventions with primary care providers, nurses, dieticians, pharmacists, and community health workers (CHWs) designed to improve glucose and cardiovascular control in diverse patient populations have resulted in mixed results. 3,4 However, the most effective interventions studied to date consist of multidisciplinary teams providing a range of components. 3 Within the routine clinical environment, these interventions are most consistent with the patient-centered medical home framework.…”

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confidence: 99%

“…[7][8][9] A recent metaanalysis of diabetes outcomes with clinical pharmacy support identified 35 studies and found a moderate effect representing a mean reduction in hemoglobin A 1c (HbA1C) of 1.1% (95% confidence interval [CI] 0.88-1.27) with pharmacist care in the ambulatory setting. 4 Pharmacist involvement varied from providing patient education to medication adjustment via prescriptive authority.…”

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confidence: 99%

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Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

et al. 2017

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OBJECTIVES To evaluate the effectiveness of clinical pharmacists and community health workers (CHWs) in improving glycemic control within a low-income ethnic minority population. METHODS In a two-arm 2-year crossover trial, 179 African-American and 65 Hispanic adult patients with uncontrolled diabetes mellitus (hemoglobin A 1c [HbA1C] of 8% or higher) were randomized to CHW support either during the first or second year of the study. All participants received clinical pharmacist support for both years of the study. The primary outcome was change in HbA1C over 1 and 2 years. RESULTS Similar HbA1C declines were noted after receiving the 1 year of CHW support: À0.45% (95% confidence interval [CI] À0.96 to 0.05) with CHW versus À0.42% (95% CI À0.93 to 0.08) without CHW support. In addition, no differences were noted in change on secondary outcome measures including body mass index, systolic blood pressure, high-density lipoprotein and low-density lipoprotein cholesterol, quality of life, and perceived social support. A difference in diastolic blood pressure change was noted: 0.80 mm Hg (95% CI À1.92 to 3.53) with CHW versus À1.85 mm Hg (95% CI À4.74 to 1.03) without CHW support (p=0.0078). Patients receiving CHW support had more lipid-lowering medication intensifications (0.39 [95% CI 0.27-0.52]) compared with those without CHW support (0.26 [95% CI 0.14-0.38], p<0.0001). However, no significant differences in intensification of antihyperglycemic and antihypertensive medications were observed between patients receiving CHW support and those without CHW support. Patients with low health literacy completed significantly more encounters with the pharmacist and CHW than those with high health literacy, although outcomes were comparable. CONCLUSIONS No significant differences were noted between a clinical pharmacist-CHW team and clinical pharmacist alone in improving glycemic control within a low-income ethnic minority population.

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Section: Discussionsupporting

confidence: 70%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

et al. 2017

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Assessment of Interprofessional Collaborative Practices and Outcomes in Adults With Diabetes and Hypertension in Primary Care

et al. 2021

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IMPORTANCE Interprofessional collaborative practice (ICP), the collaboration of health workers from different professional backgrounds with patients, families, caregivers, and communities, is central to optimal primary care. However, limited evidence exists regarding its association with patient outcomes. OBJECTIVE To examine the association of ICP with hemoglobin A 1C (HbA 1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels among adults receiving primary care.

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Mobile Health Intervention in Patients With Type 2 Diabetes

Gerber,

Biggers,

Tilton

et al. 2023

JAMA Netw Open

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ImportanceClinical pharmacists and health coaches using mobile health (mHealth) tools, such as telehealth and text messaging, may improve blood glucose levels in African American and Latinx populations with type 2 diabetes.ObjectiveTo determine whether clinical pharmacists and health coaches using mHealth tools can improve hemoglobin A1c (HbA1c) levels.Design, Setting, and ParticipantsThis randomized clinical trial included 221 African American or Latinx patients with type 2 diabetes and elevated HbA1c (≥8%) from an academic medical center in Chicago. Adult patients aged 21 to 75 years were enrolled and randomized from March 23, 2017, through January 8, 2020. Patients randomized to the intervention group received mHealth diabetes support for 1 year followed by monitored usual diabetes care during a second year (follow-up duration, 24 months). Those randomized to the waiting list control group received usual diabetes care for 1 year followed by the mHealth diabetes intervention during a second year.InterventionsThe mHealth diabetes intervention included remote support (eg, review of glucose levels and medication intensification) from clinical pharmacists via a video telehealth platform. Health coach activities (eg, addressing barriers to medication use and assisting pharmacists in medication reconciliation and telehealth) occurred in person at participant homes and via phone calls and text messaging. Usual diabetes care comprised routine health care from patients’ primary care physicians, including medication reconciliation and adjustment.Main Outcomes and MeasuresOutcomes included HbA1c (primary outcome), blood pressure, cholesterol, body mass index, health-related quality of life, diabetes distress, diabetes self-efficacy, depressive symptoms, social support, medication-taking behavior, and diabetes self-care measured every 6 months.ResultsAmong the 221 participants (mean [SD] age, 55.2 [9.5] years; 154 women [69.7%], 148 African American adults [67.0%], and 73 Latinx adults [33.0%]), the baseline mean (SD) HbA1c level was 9.23% (1.53%). Over the initial 12 months, HbA1c improved by a mean of −0.79 percentage points in the intervention group compared with −0.24 percentage points in the waiting list control group (treatment effect, −0.62; 95% CI, −1.04 to −0.19; P = .005). Over the subsequent 12 months, a significant change in HbA1c was observed in the waiting list control group after they received the same intervention (mean change, −0.57 percentage points; P = .002), while the intervention group maintained benefit (mean change, 0.17 percentage points; P = .35). No between-group differences were found in adjusted models for secondary outcomes.Conclusions and RelevanceIn this randomized clinical trial, HbA1c levels improved among African American and Latinx adults with type 2 diabetes. These findings suggest that a clinical pharmacist and health coach–delivered mobile health intervention can improve blood glucose levels in African American and Latinx populations and may help reduce racial and ethnic disparities.Trial RegistrationClinicalTrials.gov Identifier: NCT02990299

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Impact of Diabetes Care by Pharmacists as Part of Health Care Team in Ambulatory Settings: A Systematic Review and Meta-analysis

Abstract: Pharmacists' interventions as part of the patient's health care team improved diabetes therapeutic outcomes, substantiating the important role of pharmacists in team-based diabetes management.

Cited by 80 publications

References 64 publications

Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

Assessment of Interprofessional Collaborative Practices and Outcomes in Adults With Diabetes and Hypertension in Primary Care

Mobile Health Intervention in Patients With Type 2 Diabetes

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