1238-P: Utilization of Comprehensive Pharmacy Services in Diabetes Care Coordination for Hospitalized Patients

A major barrier to effective diabetes care is difficulty with affording and knowing how to use medications. At a 750-bed urban hospital, comprehensive pharmacy services (PS) are offered to support patients in accessing and understanding their medications. Specifically, Medication Access Services (MAS) collaborates with providers and patients to utilize available resources that assist patients in obtaining needed medications. We examined use of these services in a cohort of inpatients with poorly controlled diabetes who were enrolled in a diabetes care-coordination program after discharge, Sweet Transitions (ST). Because participation in ST had been associated with significant reductions in HbA1c (12.0 to 9.0%) and 30-day readmissions, both sustained at one year, the role of PS utilization was explored. We hypothesized that there was greater use of PS among ST participants compared to matched controls and that this may have contributed to the improved outcomes observed. We reviewed data from 544 patients; 197 ST participants with poorly controlled diabetes (A1C ≥ 9) and 347 controls matched for poor diabetes control and cardiovascular disease. Utilization of PS and MAS within 90 days after discharge was compared. Cost savings, defined as expenditures for medications covered by sources outside the patient or healthcare system, were calculated. Compared to 49% of controls, 77% of ST patients used PS, p<0.001. Specifically, 2.6% of the controls vs. 9.1% of the ST cohort utilized MAS, p=0.002. The total cost savings in the ST group using MAS was $61,180 or $3399 per patient. Patients enrolled in the ST program utilized comprehensive pharmacy services more often than controls, suggesting that such services may have contributed to the significant and sustained improved outcomes observed. Approaches that assist patients with the affordability, access, and understanding of their diabetes medications may contribute to sustainably improved outcomes and should be examined further.