Impact of Clinical Pharmacist Intervention on Diabetes-Related Outcomes in a Military Treatment Facility

Abstract

Clinical pharmacist management of patients with diabetes has been well justified, but there is a lack of research that evaluates the impact of pharmacist-managed diabetes care versus standard medical care on American Diabetes Association (ADA) treatment goals other than hemoglobin A(1c) (A1C). To evaluate the reduction in A1C, blood pressure, and low-density lipoprotein cholesterol (LDL-C) for patients with diabetes whose care was managed by a clinical pharmacist and compare these values to those of a cohort of patients whose care was managed by primary care providers. The difference in percentage of patients attaining ADA treatment goals between the 2 groups was also evaluated. This retrospective chart review identified 98 diabetic patients managed by a clinical pharmacist with at least 2 A1C measurements between September 15, 2008, and March 15, 2011. The Military Health System Population Health Portal was used to identify a similar group of patients with diabetes managed by their primary care provider (N = 90). The Armed Forces Health Longitudinal Technology Application was used to collect baseline data and the most recent measurements for A1C, blood pressure, LDL-C, and documented immunizations. The pharmacist group saw positive improvements in all primary end points, including a 1.6% reduction in A1C, a 9-mm Hg and 1.4-mm Hg reduction in systolic and diastolic blood pressure, respectively, and a 16.3-mg/dL reduction in LDL-C. Conversely, the control group had an increase of 0.8% in A1C and 1.5 mm Hg in diastolic blood pressure. Reductions in systolic blood pressure and LDL-C were much less robust than in the pharmacist group (1.6 mm Hg and 5.2 mg/dL, respectively). Overall, patients in the pharmacist group were more likely to achieve ADA treatment goals. Pharmacist management of patients with diabetes significantly reduces A1C and allows more patients to meet ADA treatment goals. A clinical pharmacist-run diabetes clinic can provide numerous clinical benefits to patients.