Pharmacist-Managed Diabetes Center Interventions Ensure Quality and Safety in Elderly Patients.

Abstract

This quality-improvement study aimed to replicate historical Patient Safety Clinical Pharmacy Services Collaborative results in high-risk Medicare beneficiaries with diabetes to achieve reductions in A1C, adverse drug events (ADEs), and potential ADEs (pADEs). The model included an interdisciplinary team led by a pharmacist located inside a community pharmacy to provide disease state management and medication therapy management (MTM) to the study population. Apple Discount Drugs is an independent community pharmacy located in Salisbury, Maryland. The interdisciplinary team included pharmacists, respiratory therapists, durable medical equipment (DME) specialists, and a referring prescriber. High-risk Medicare beneficiaries, defined as patients with A1C > 9.0% and/or a documented history of three or more hypoglycemic events in the previous six months (defined by blood glucose < 70 mg/dL, patient-described signs and symptoms of hypoglycemia, or a combination of each). All patients were 65 years of age and older and diagnosed with type 2 diabetes mellitus. Patients received longitudinal diabetes self-management education (DSME) and MTM from pharmacist certified diabetes educators. MTM included a comprehensive medication review performed by a pharmacist. The study looked at the effects of the program's interventions on A1C and ADEs. The study cohort saw a 90% reduction of patients with an A1C > 9.0% compared with baseline. ADEs were reduced by 49% and pADEs were reduced by 67%. An integrated, pharmacist-directed DSME and MTM program for high-risk Medicare beneficiaries resulted in improvements in A1C quality measure and mitigated medication associated harm.