Maintenance of Goal Blood Pressure, Cholesterol, and A1C Levels in Veterans With Type 2 Diabetes After Discharge From a Pharmacist-Managed Ambulatory Care Clinic.

Abstract

Objective. This study evaluated the ability of patients with type 2 diabetes to maintain systolic blood pressure (SBP), LDL cholesterol, and A1C at goal levels after being discharged from a pharmacist-managed ambulatory care clinic. The goals of this study were to 1) document the length of time to failure of maintenance of each goal and 2) characterize risk factors that may be associated with a shorter time to failure.Methods. Researchers reviewed the medical records of veterans with diabetes who were discharged from the clinical pharmacy ambulatory care clinic between 1 July 2007 and 30 June 2009 after attaining their goal SBP, LDL cholesterol, or A1C. The time to goal failure, medical history, laboratory data, medications, demographic information, and clinic appointment attendance were documented.Results. A total of 69 patients who were discharged from the clinic after meeting their SBP, LDL cholesterol, or A1C goal subsequently failed to maintain that goal. The mean time to failure was 9.4 months (SD 8.75 months) for SBP, 25.8 months (27.45 months) for LDL cholesterol, and 20.4 months (15.1 months) for A1C. Multiple risk factors were associated with a shorter time to failure of maintenance of SBP and A1C goals.Conclusion. Veterans with type 2 diabetes in this study demonstrated durable maintenance of their goal LDL cholesterol and A1C levels after being discharged from a pharmacist-managed ambulatory care clinic. However, maintenance of xSBP goals did not demonstrate the same durability. Patients who meet their SBP goal may benefit from receiving continued disease state management services from a pharmacist-managed ambulatory care clinic instead of being discharged to receive their usual care.