Evaluation of the change in glycated hemoglobin for patients in an employee health program formerly managed by a pharmacist-run ambulatory care clinic.

Abstract

To evaluate the change in mean glycated hemoglobin (HbA1c) for patients with diabetes in an employee health program after discontinuation of management by a clinical pharmacist. This was a single-center, retrospective chart review of patients followed by a clinical pharmacist from January 1, 2020, through March 31, 2021. Patients included had type 2 diabetes, were 18 years of age or older, were not pregnant, and were not using an insulin pump. The baseline visit was defined as the last pharmacist visit within the study period. The follow-up visit was defined as the most recent visit upon chart review that occurred at least 5 months after the baseline visit. The primary and secondary endpoints were the mean change in HbA1c and number of antihyperglycemic agents from baseline to follow-up, respectively. Statistical analysis included descriptive statistics for baseline characteristics, a paired t test for the primary endpoint, and a McNemar test for the secondary endpoint. A total of 590 patients were screened, of whom 131 were included in the analysis. For the primary outcome, the mean baseline HbA1c was 7.3% while that at follow-up was 7.41% (mean change of 0.11%; SD, 1.22%; P = 0.326). For the secondary outcome, the baseline number of antihyperglycemic agents was 274 while the follow-up number was 276. There were no statistically significant differences for the primary and secondary outcomes. This study highlights a unique patient population with controlled HbA1c at baseline, for whom diabetes control may potentially be influenced by the patients' employment within a healthcare system and improved access to care. The lack of a significant difference in the primary endpoint implies that it may be appropriate to limit or have less frequent pharmacist visits for well-controlled patients. Further research should investigate how to identify patients who would benefit from continued follow-up with a clinical pharmacist vs those who can be managed with minimal resources.