Effects of a Community Pharmacist-Based Diabetes Patient-Management Program on Intermediate Clinical Outcome Measures

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OBJECTIVES: Evaluate a community pharmacist-based diabetes patient-management program by examining the pharmacists' impact on five intermediate outcomes: glycosolated hemoglobin (HbA1c), blood pressure, body mass index, lipid levels, and medication use in patients with diabetes. SETTING: A network of community pharmacies in West Virginia and southeastern Ohio. PATIENTS: The program was available to all patients with diabetes who attended the network pharmacies regardless of baseline glycemic control. Of the 47 patients initially enrolled, 32 stayed in the program for at least 6 months during the year-long study (median time in program was 9 months). INTERVENTION: Pharmacists provided a basic, standardized diabetes education program during three 1-hour sessions. This was accompanied by a clinical assessment and a report to the patient's primary care physician. The patients met with the pharmacist every 3 months for continued monitoring. After each visit, the patient's primary care physician was sent a report along with recommendations for drug therapy modification when appropriate. MAIN OUTCOME MEASURES: HbA1c, blood pressure, total cholesterol, low density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides, body mass index, and the number of drug therapy modifications. RESULTS: There was significant improvement in total cholesterol (t= 2.58, p=0.015) and LDL (t= 2.56, p=0.017) for the 32 participating patients. HbA1c, BMI, blood pressure, HDL and triglycerides did not change significantly across all patients. For a subgroup of 10 patients with baseline HbA1cgreater than8%, average HbA1c declined significantly from 9.8% to 8.6% (t= 3.00, p=0.015). During the study, the 32 patients had a total of 53 modifications to their medication regimens. The most common was a change in dose of oral diabetes medications. CONCLUSIONS: The pharmacist-based diabetes patient-management program was associated with improvements in total cholesterol and LDL across all patients who maintained enrollment in the program for at least 6 months. Improvements in HbA1c were also demonstrated for a subgroup of patients who had poor glycemic control at baseline.