1271-P: Impact of Physician-Pharmacist Collaboration on A1C in an Interprofessional Endocrinology Clinic

Abstract

Background: Comprehensive medication management (CMM) ensures an individualized plan for medication appropriateness, effectiveness, safety, and adherence. It is most often performed by pharmacists within a pharmacist-physician collaborative agreement. Published studies on CMM are few and mostly conducted in primary care settings. The aim of our study was to determine the impact of CMM on the proportion of patients that achieve ≥ 1% A1c reduction in an interprofessional specialty clinic. Methods: This is a retrospective study comparing 2 groups: group 1-without pharmacist collaboration, group 2-with pharmacist collaboration. Subjects were adults with diabetes and most recent A1c ≥ 8.5% with at least one visit in the interprofessional endocrinology clinic between 1/2016-12/2017. Exclusion criteria were pregnancy, no A1c within 6 weeks of initial visit, and no follow-up A1c. The 2 groups were matched for initial A1c, type of diabetes, age, and BMI. Results: A total of 162 participants were included. Baseline characteristics were similar between groups: Group 1: (mean age: 57.6 ± 15.8 years, BMI: 34.3 ± 8.1 kg/m2, A1c: 10.2 ± 1.2%, T1DM: 26%), Group 2 (mean age: 56.0 ±16.4 years, BMI: 32.6 ± 8.1 kg/m2, A1c: 10.1± 1.3%, T1DM: 26%). The percentage of subjects achieving ≥1% A1c reduction at 6 months was 58.0% in Group 2 compared to 40.7% in Group 1, p=0.041. More subjects achieved A1c < 8% in group 2 (32.1%) vs. Group 1 (18.5%), p=0.047. The frequency of endocrinologist visits was more in group 1 (2.37/patient) vs. group 2 (1.89/patient), p=0.01. Group 2 averaged 3.0 pharmacist visits per patient. Discussion: Physician-pharmacist collaboration led to greater A1c reduction compared to usual endocrinologist care in patients with uncontrolled A1c. However, frequency of total provider visits may account for some differences. Overall, utilizing pharmacists within diabetes health care models may reduce frequency of endocrinologist visits while improving glycemic control. Disclosure D. Isaacs: Advisory Panel; Self; BD, Sanofi-Aventis. R.S. Zimmerman: Consultant; Self; Novo Nordisk Inc. Research Support; Self; Merck & Co., Inc., Novo Nordisk Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute, Merck & Co., Inc. M. Lansang: None.