Evaluation of Diabetes Mellitus Type 2 Control in Home-Based Primary Care Patients Managed by Clinical Pharmacy Specialists.

Abstract

Purpose To evaluate the impact of pharmacist-led diabetes care in a Home-Based Primary Care (HBPC) setting. Methods This was a single-center, retrospective, cohort chart review in HBPC veterans with diabetes mellitus type 2 (DMII) at Columbia VA Health Care System. A sample size of 80 patients was calculated to meet power of 80% and a P-value of less than 0.05 was used to determine clinical significance. The primary outcome was mean hemoglobin A1C (HgbA1C) change after up to 18 months of Clinical Pharmacy Specialist (CPS) diabetes-led care stratified by baseline HgbA1C. Secondary outcomes included change in the number of diabetes medications and doses per day stratified by baseline HgbA1C. Results One hundred twelve patients were included in the final analysis based on inclusion and exclusion criteria. The mean absolute HgbA1C reduction was 0.51%, 95% CI -0.20 to -0.82 from 8.1% at baseline. For the subgroup analyses, patients with baseline HgbA1C less than 8.5%, had a nonsignificant increase in their HgbA1C, while patients with HgbA1C 8.5% or more showed significant reductions in HgbA1C (P < 0.05). Patients with baseline HgbA1C less than 6.5% had a significant decrease of 0.52, 95% CI -0.18 to -0.87 and patients with baseline HgbA1C 6.5% or more had a nonsignificant increase in the number of diabetes medications (P > 0.05). Patients with baseline HgbA1C of less than 7.5% and 9.5% or more had a decrease in the number of diabetes medication doses with results being significant for patients with HgbA1C less than 6.5%, 95% CI -0.58 to -1.89. Conclusion The results of this study suggest that HBPC CPSs are improving glycemic control in HBPC veterans while simplifying diabetic regimens with attention to hypoglycemic risk reduction.