Evaluation of pharmacist-managed diabetes mellitus under a collaborative drug therapy agreement.
ABSTRACT The effect of a pharmacist-managed collaborative drug therapy agreement (CDTA) on diabetes mellitus (DM) management in an outpatient setting is evaluated.
Patients with DM were referred by physicians to the pharmacist for either education or clinical management of DM under the CDTA. A retrospective chart review was conducted between September 2001 and December 2005 and included patients who had laboratory values of interest within one year before and after the initial visit and who had more than two documented visits with the pharmacist. After the pharmacist's intervention in the DM management, glycosylated hemoglobin (HbA(1c)) and low-density lipoprotein cholesterol were compared using a paired sample t test. Average costs for inpatient hospitalization and emergency department (ED) admission were also compared.
A total of 110 patients had a mean +/- S.D. of 5.7 +/- 3.9 visits with the pharmacist. A mean reduction in HbA(1c) of 0.7% (p < or = 0.001, n = 93) from 8.9% to 8.2% and a mean reduction in blood glucose of 26.4 mg/dL (p < or = 0.001, n = 99) were achieved. Average costs for inpatient hospitalization and ED admissions were significantly higher in the preintervention period than in the postintervention period for patients with DM as the primary or secondary diagnosis ($2434 versus $636, respectively; p = 0.015). For patients with a primary diagnosis of diabetes, preintervention costs were higher than postintervention costs, but this difference was not significant ($3082 versus $696, respectively; p = 0.100).
Pharmacist interventions under a CDTA resulted in significant improvements in glucose and HbA(1c) levels in patients with DM. Postintervention costs for inpatient hospitalization and ED services were significantly less than preintervention costs when DM was a primary or secondary diagnosis for the admission.
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ABSTRACT: Should hospital pharmacists be prescribing medications? This question reminds me of the age-old record player in my cabin, which keeps playing the same song over and over. Although in the past this question has been debated numerous times, recent changes to our practice landscape may finally help us to answer this question once and for all. Formerly recognized mainly for distributive functions, pharmacists in all settings are now involved in health promotion, disease-state management, and pharmaceutical care, as well as both collaborative and independent prescribing. As our roles have evolved to become more clinically focused, prescribing has become a logical extension of the provision of comprehensive pharmaceutical care. 1 Hospital pharmacists have a long history of being leaders in prescribing, such as in pharmacokinetic dosing services, anticoagulation management, and therapeutic inter-change programs. So, when the question is asked, "Should hospital pharmacists prescribe?" the answer is obvious! We have been doing it for decades. While not an entirely new concept, prescribing by hospital pharmacists has continued to expand in recent years. According to the 2011/2012 Hospital Pharmacy in Canada survey, 55% of responding hospitals indicated that pharmacist prescribing existed in their institutions. 2 An increase in independent prescribing activities (as opposed to independent prescribing) was also noted, relative to previous years. For instance, in the 2007/2008 survey, about a quarter (24%) of respondents reported having independ-ent prescribing rights for dosage adjustments, and the proportion doubled, to 48%, in the 2011/2012 survey. 2,3 The trend for increasing prescribing by pharmacists is likely to continue, given changes to the legal framework that are occurring across Canada. Alberta was the first province to grant pharmacists prescribing privileges (in 2007), and currently all provinces have some form of expanded scope-of-practice legislation in place 4 and are at various stages of obtaining prescriptive authority. Support for pharmacist prescribing is echoed by our national pharmacy societies, which continue to advocate for prescriptive authority. For example, the Blueprint for Pharmacy envisions that pharmacists will "initiate, modify and continue drug therapy and order tests". 4 The Position Statement on Pharmacist Prescribing of the Canadian Pharmacists Association states that "pharmacists will take on increased accountability for patient-centred, outcomes focused care", 5 and the Canadian Society of Hospital Pharmacists "advocates the role of pharmacists as capable prescribers and supports the pharmacist's role in a collaborative prescribing model". 6 These views are not limited to Canada. 7 The 2008 Basel Statements, reflecting the perceptions of pharmacists from 98 countries, acknowledged the benefits of allowing hospital pharmacists to prescribe. 8The Canadian journal of hospital pharmacy 01/2014; 67(67):5-2014. DOI:10.4212/cjhp.v67i5.1395
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ABSTRACT: Objectives: Pharmacist-managed collaborative services in a family practice setting are described, and diabetes and hypertension outcomes are assessed. Methods: Pharmacist-managed clinics, pharmacotherapy consultations, and drug information services are provided for a medically underserved, predominantly African American population. A pharmacy residency director, an ambulatory care pharmacy resident and three PharmD candidate student pharmacists work directly with physicians, nurse practitioners, nurses, and social workers to form an interdisciplinary health care team. Providers utilize pharmacy services through consultations and referrals. Collaboration outcomes were evaluated in twenty-two patients with diabetes and thirty hypertensive patients. Patients were retrospectively followed throughout their history with pharmacy service. Hemoglobin A1c (A1C) was tracked before referral to pharmacy services, 3 to 6 months after, and as the most current measure after at least 6 months. Blood pressure (BP) was observed before pharmacy involvement, 2 to 4 months later, and then currently for at least 4 months with the service. The mean of the most current markers was calculated, and the percent of patients at their goal marker was compared to national averages. Results: Fifty percent of pharmacy service patients met the American Diabetes Association hemoglobin A1c goal of less than 7% in our evaluation compared to the national mean of 49.8% overall and 44% in African Americans. Thirty percent of patients were at their BP goal while 33.1% of patients without diabetes and 33.2% of patients with diabetes nationally are at goal. Conclusion: The medically underserved patients under the care of pharmacy services achieved a higher percentage at their A1C goal than the national mean. The percentage of patients who achieved their BP goals was comparable to the national average. Increasing utilization of pharmacy services in the family practice setting allows for pharmacists and providers to form a trusted relationship while providing enhanced care and potentially improved outcomes for patients.Pharmacy Practice 12/2009; 7(4):248-253.
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ABSTRACT: Patient adherence to prescribed medication regimens is important in diabetes care to prevent or delay microvascular and macrovascular complications such as retinopathy, nephropathy and myocardial infarction. In Penang Hospital, Malaysia, pharmacists collaborate with physicians in diabetes care through a pharmacist-managed Diabetes Medication Therapy Adherence Clinic (DMTAC) in the Endocrine Clinic, in operation since 2006. Objective: To evaluate the effectiveness of the pharmacist-managed DMTAC program in improving glycaemic control, lipid parameters and patients´ medication adherence. Method: A retrospective study among patients enrolled in the DMTAC program was conducted between September 2007 and December 2008. Data was included from patients with a glycosylated haemoglobin (HbA1c) >8% and who had completed eight visits with the pharmacists. Medical records and DMTAC forms that provided patients´ demographics, medication regimens, adherence and laboratory parameters as well as pharmacists´ interventions were reviewed. HbA1c, fasting blood glucose (FBG), low-density lipoprotein cholesterol (LDL), triglycerides (TG) and high-density lipoprotein cholesterol (HDL) were evaluated. Documented data of patients´ adherence to medication regimen [Modified Morisky Medication Adherence Score (MMMAS); high adherence if score >8, medium adherence if score 6 to <8 and low adherence if score <6] was also evaluated. Results: A total of 43 patients (53.5% females; 46.5% Malays, 44.2% Chinese and 9.3% Indians) were included in the analysis. A mean reduction in HbA1c of 1.73% (p<0.001), mean reduction in FBG of 2.65mmol/l (p=0.01) and mean reduction in LDL cholesterol of 0.38mmol/l (p=0.007) were achieved. The difference in TG and HDL cholesterol were not significant. Patients´ adherence to medication regimens improved significantly with an increase in the mean MMMAS score from 7.00 to 10.84 (p<0.001) after completion of the DMTAC program. Conclusion: The pharmacist-managed DMTAC program resulted in significant improvements in HbA1c, glucose and LDL cholesterol levels as well as medication adherence in patients with diabetes.Pharmacy Practice 12/2010; 8(4):250-254.