Implementation of a pharmacist-supervised outpatient diabetes treatment clinic

Abstract

The implementation of a pharmacist-managed Veterans Affairs (VA) clinic for high-risk patients with type 2 diabetes is described, including a review of first-year performance data. As part of VA's ongoing initiative to improve chronic disease management by creating multidisciplinary Patient-Aligned Care Teams (PACTs) that include clinical pharmacy specialists, an outpatient diabetes treatment clinic was implemented at a VA site in Massachusetts. Operated two days weekly, the clinic provides continuity of care between physician visits by applying standard protocols and procedures for insulin therapy; oral medication and insulin doses are adjusted according to self-monitored blood glucose values and other health data transmitted by patients via telephone or secure messaging system. The clinic pharmacist monitors patients' progress toward attainment of glycosylated hemoglobin (HbA1c) goals and provides frequent followup and education to prevent hypoglycemia. During its first year of operation, the clinic enrolled 160 veterans. Among 85 patients included in a three-month review of outcomes data, the mean ± S.D. HbA1c concentration declined by more than one percentage point (from 9.12% ± 1.41% to 7.94% ± 1.18%). Further HbA1c improvements were documented in a subset of 46 patients followed for six months after clinic enrollment, with no episodes of severe hypoglycemia. An outpatient clinic successfully integrated a pharmacist into a multidisciplinary PACT focused on veterans with poorly controlled type 2 diabetes. The clinic's initial experience suggests that frequent pharmacist interventions have a positive impact in promoting appropriate insulin use in this high-risk patient population.