Using an Advanced Practice Pharmacist in a Team-Based Care Model to Decrease Time to Hemoglobin A<sub>1c</sub> Goal Among Patients With Type 2 Diabetes, Florida, 2017–2019

Cowart, Kevin; Updike, Wendy H.; Emechebe, Nnadozie; Zgibor, Janice C.

doi:10.5888/pcd17.190377

Cited by 6 publications

(2 citation statements)

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“…Since the seminal work of the Asheville Project demonstrated the effect of clinical pharmacists on improving outcomes in diabetes, hypertension, and hyperlipidemia in 2003 (24,25), pharmacist participation in care coordination to manage chronic conditions has been consistently demonstrated. Cowart et al described how a physician-pharmacist team brought a cohort of patients with diabetes to the hemoglobin A 1c goal of less than 7.0% in 99 fewer days than the usual medical care of physician alone (26).…”

Section: Pharmacy Contributions To Improving Population Healthmentioning

confidence: 99%

Pharmacy Contributions to Improved Population Health: Expanding the Public Health Roundtable

et al. 2020

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Section: Pharmacy Contributions To Improving Population Healthmentioning

confidence: 99%

Pharmacy Contributions to Improved Population Health: Expanding the Public Health Roundtable

et al. 2020

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“…4 Pharmacist-physician practice models (PPMs) may improve therapeutic inertia, with existing evidence supporting a greater reduction in hemoglobin A 1C (A1C), shorter time to achieving a A1C goal of <7%, and a shorter time to antidiabetic treatment intensification (TI) as compared with usual medical care (UMC). [5][6][7][8] However, the mechanism underlying these improvements along with characteristics of patients experiencing higher rates of TI are not well understood. With a greater understanding of how team-based care practice models reduce time to TI, health care organizations may be better positioned to implement targeted clinical pharmacy services that provide the greatest benefit on attainment of optimal glycemic control in patients with T2D.…”

Section: Introductionmentioning

confidence: 99%

Measurement of Pharmacist-Physician Collaborative Care on Therapeutic Inertia in Patients With Type 2 Diabetes

et al. 2021

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Background Team-based care practice models have been shown to improve diabetes-related therapeutic inertia, yet the method and type of antidiabetic treatment intensification (TI) leading to improvements in glycemic control are not well understood. Objective To evaluate time to TI in a pharmacist-physician practice model (PPM) as compared with usual medical care (UMC), explore the method and type of antidiabetic TI, and evaluate achievement of hemoglobin A1C (A1C) goal among each cohort. Methods This was a retrospective cohort study conducted between January 1, 2017, and December 31, 2018. Median time to TI was calculated and compared between patients in the PPM and UMC groups using the log rank test. Descriptive statistics were used to evaluate the method and type of TI and A1C goal achievement. Results A total of 56 patients were included. The median (interquartile range) time to antidiabetic TI among the PPM cohort was 37.5 days (8, 216.5), as compared with 142 days (16, 465) in the UMC cohort ( P = 0.19). At 1 year post–index date, 25% of patients in the PPM cohort reached their A1C goal compared with 18.8% of patients in the UMC cohort. This effect was maintained in the subgroup (n = 49) of patients receiving TI (23.1% vs 17.8%). Conclusion and Relevance A shorter time to TI and improvement in A1C goal achievement was observed with pharmacist-physician care compared with UMC. These findings suggest that pharmacist-physician care may be one of several interventions necessary to overcome therapeutic inertia in diabetes care.

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Pharmacist‐managed diabetes care and change in A1C: A retrospective matched cohort study

Meyer,

Younes,

Grindeland

et al. 2024

J Am Coll Clin Pharm

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IntroductionStudies have demonstrated the positive impact of pharmacist‐managed diabetes care (PMDC) on hemoglobin A1C (A1C) reduction from baseline, but data comparing the pharmacist's impact on usual medical care (UMC) are less robust.ObjectivesThis study compared the A1C reduction in patients with diabetes enrolled in PMDC plus UMC (PMDC + UMC) with similar patients receiving UMC independent of clinical pharmacy services.MethodsThis was a retrospective, matched cohort study conducted at a large, not‐for‐profit healthcare system in North Dakota. Patients with diabetes who received care from an ambulatory care pharmacist in addition to UMC between July 2018 and June 2020 were included in the PMDC+UMC cohort. The comparator cohort included propensity‐matched patients solely receiving UMC during the same period. The primary endpoint was the mean change in A1C at 12 months in both cohorts. The secondary endpoint was the percentage of patients in each cohort achieving an A1C <7% at 12 months. Normally distributed continuous variables were analyzed using the Wilcoxon rank sum test. Categorical data were analyzed using Chi‐square tests.ResultsIn total, 158 patients managed by a pharmacist met the inclusion criteria for the study. A matched cohort of 158 practitioner‐managed patients was used for comparison. Pharmacist‐managed patients achieved a greater mean reduction in A1C (−1.70%) at 12 months compared with those managed by practitioners only (−1.31%), a between‐means difference of −0.39% (p = 0.0073). More patients managed by pharmacists (24.6%) reached an A1C of <7% compared with patients receiving UMC only (22.8%); however, the difference was not statistically significant.ConclusionIncorporation of PMDC for patients with diabetes is associated with a greater improvement in A1C at 12 months compared with UMC alone. Although not statistically significant, more patients referred to PMDC reached an A1C of <7%. Implementation of similar PMDC programs may help more patients reach their glycemic goals.

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Using an Advanced Practice Pharmacist in a Team-Based Care Model to Decrease Time to Hemoglobin A_1c Goal Among Patients With Type 2 Diabetes, Florida, 2017–2019

Cited by 6 publications

References 6 publications

Pharmacy Contributions to Improved Population Health: Expanding the Public Health Roundtable

Pharmacy Contributions to Improved Population Health: Expanding the Public Health Roundtable

Measurement of Pharmacist-Physician Collaborative Care on Therapeutic Inertia in Patients With Type 2 Diabetes

Pharmacist‐managed diabetes care and change in A1C: A retrospective matched cohort study

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Using an Advanced Practice Pharmacist in a Team-Based Care Model to Decrease Time to Hemoglobin A1c Goal Among Patients With Type 2 Diabetes, Florida, 2017–2019

Cited by 6 publications

References 6 publications

Pharmacy Contributions to Improved Population Health: Expanding the Public Health Roundtable

Pharmacy Contributions to Improved Population Health: Expanding the Public Health Roundtable

Measurement of Pharmacist-Physician Collaborative Care on Therapeutic Inertia in Patients With Type 2 Diabetes

Pharmacist‐managed diabetes care and change in A1C: A retrospective matched cohort study

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Product

Resources

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Using an Advanced Practice Pharmacist in a Team-Based Care Model to Decrease Time to Hemoglobin A_1c Goal Among Patients With Type 2 Diabetes, Florida, 2017–2019