Evaluation of Diabetes-Related Outcomes Up to Two Years after Discharge from Ambulatory Clinical Pharmacist Clinics in a Large Public Safety Net Health System

There are 10 clinical ambulatory pharmacy specialist (CAPS) providing direct patient care under physician-approved drug therapy management protocols within the health system. Patients were referred to CAPS by their primary care physician (PCP) and subsequently discharged from CAPS services when individualized diabetes goals were met. Patients continued follow-up with their PCP for continuity of care. The primary outcomes are the A1Cs at 1 year (± 90 days) and 2 years (± 90 days) post-discharge from CAPS. Secondary outcomes include 1 and 2 year results in the number of emergency department (ED) visits, hospitalizations, and other clinical visits completed.

Results: At baseline, patients discharged from CAPS had an A1C of 6.7% (n=195). At 1 and 2 year post-discharge, the A1Cs were 7.5% (n=118) and 8% (n=100), respectively. In the first year following discharge, 1 patient had an ED visit and 2 patients required hospitalization for diabetes-related events. In the second year post discharge, 3 patients were seen in the ED and 4 diabetes related hospitalizations occurred. Patients continued to see their PCP 2.7 and 2.3 times a year in the first and second year post-discharge, respectively. A small number of patients were referred to nutrition (n=16), diabetes classes (n=2), and diabetes clinic (n=5) in the 2 year time frame. Patients were also referred back to CAPS for continued diabetes management (n=5 in year 1, n=13 in year 2) and these A1Cs were removed from analysis. While not all patients discharged from CAPS had subsequent A1Cs for analysis, the main reason identified was a lack of A1C results in the specified time frame.

Conclusions: Patients were able to fairly control their diabetes up to 2 years after discharge from clinical pharmacy services.