Implementation of a pharmacistrun telephonic insulin titration service
OBJECTIVES To describe an insulin titration-by-phone service conducted by pharmacists and to discuss the effects of this service on patient care and outcomes in the first year of its existence. SETTING An academic family medicine department in which pharmacists practice in nondistributory roles, from March 2009 through March 2010. PRACTICE DESCRIPTION Pharmacy services within the department include a chronic disease medication therapy management clinic as well as consultation in various other primary care and specialty clinics. Fourth-year student pharmacists complete advanced pharmacy practice experiences at this site as well. PRACTICE INNOVATION Based upon a need identified by department providers (physicians and physician assistants), an insulin titration-by-phone service was implemented by two faculty pharmacists. Patients were referred into this service by their primary care provider (PCP) and were called by one of the pharmacists on a regular basis. Pharmacist recommendations for insulin dose adjustments were made based on patient reported self-monitored glucose values. PCP approved recommendations and the patient was notified of changes. MAIN OUTCOME MEASURE Decrease in glycosylated hemoglobin (A1C ) within 9 months of referral to the service when compared with baseline. RESULTS Analysis included 76 patients. The mean decrease in A1C was 1.55% (SD 2.31; P <0.001). The largest decrease in A1C (1.4%) was seen in the first 3 months after referral. Seven patients achieved an A1C ≤7% ( P = 0.007). Forty-one patients had a decrease in A1C of at least 1% during the first 9 months after their referral ( P <0.001). CONCLUSION The implementation of a pharmacist-run insulin titration-by-phone service resulted in improvements in A1C that were most pronounced in the first 3 months after referral.
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