Purpose: An enhanced primary care diabetes model (EPCD) was implemented to provide proactive longitudinal care to adult patients with diabetes, grounded in close partnership between primary care providers (PCP) , registered nurses (RN) , and Medication Management Services (MMS) pharmacists. In this model, care team RNs could request pharmacist support through chart review for comprehensive diabetes management. The purpose of this study is to evaluate the impact of the MMS pharmacist in the EPCD model for patients with diabetes.
Methods: All adults with diabetes paneled to a PCP in six primary care clinics in the Midwest U.S. were eligible for the EPCD model. We compared the change in diabetes care quality between patients who received pharmacist chart review and care recommendations to matched patients who did not. The index date was defined as the date of MMS pharmacist review after referral from the care team RN or date of RN review and no subsequent pharmacist consult. The primary outcome was the change in the proportion of patients meeting the composite of four diabetes treatment goals (D4) , including hemoglobin A1c control (HbA1c less than 8%) , blood pressure control (less than 140/90 mmHg) , aspirin use if indicated, and statin use if indicated at six months from the index date. Secondary outcomes were each of the four indicators individually.
Results: The proportion of patients meeting the D4 after 6 months increased with pharmacist chart reviews (N=85) compared to matched patients with no review (N=170) (27% vs. 7%, p<0.001) . The change in patients meeting treatment goals of HbA1c (12.9% vs. 4.1%, p=0.020) , blood pressure (9.4% vs. 2.4%, p=0.023) , aspirin use (10.6% vs. 2.9%, p=0.018) , and statin use (17.6% vs. -1.2%, p<0.001) were increased with a pharmacist review.
Conclusions: Pharmacist engagement in the EPCD model improved diabetes care quality. This supports the inclusion and utilization of pharmacists in multidisciplinary efforts to improve diabetes care.
D.Hess: None. R.G.Mccoy: Consultant; Emmi. J.Matulis: None. M.Kessler: None. K.Mara: None. J.Herges: None.