Pharmacist telehealth in an underserved urban population with type 2 diabetes mellitus

Abstract

BackgroundDuring the pre-vaccine months of the COVID-19 pandemic, pharmacists providing comprehensive medication management to underserved patients with type 2 diabetes mellitus at an urban Federally Qualified Healthcare Center shifted to telephone-based telehealth. ObjectivesThis retrospective, observational cohort study evaluated the effectiveness of clinical pharmacist telehealth while identifying associations between patient characteristics and efficacy measures. MethodsPatients with uncontrolled type 2 diabetes (hemoglobin A1c (HbA1c) ≥ 8%) with a clinical pharmacist visit between April 1 and August 31, 2020, were included. Telehealth effectiveness was measured by the proportions of: 1) patients reached, 2) appointments completed, and 3) the median change in HbA1c from baseline. Interventions by the clinical pharmacist were analyzed as a secondary outcome. ResultsThere were 181 patients scheduled and 172 (95%) of those patients kept at least one appointment. Of the 667 appointments scheduled, 73% were kept. Median HbA1c was reduced from 10.2% to 9.2% over 5 months of follow-up, and 24.6% of patients achieved a HbA1c < 8% (n = 138, p < 0.0001 for each). Greater HbA1c changes were associated with higher baseline blood glucose (p = 0.01), higher baseline HbA1c (p < 0.0001), non-insulin medications at baseline (p = 0.007) and among those with more kept visits (p = 0.03). The healthcare quality impact of interventions during each appointment was favorable; 83.3% brought care to a higher standard, 1.9% averted major organ dysfunction and 0.4% prevented death. ConclusionsClinical pharmacist telehealth was effective for providing patient-centered diabetes care when in-person office visits were not an option.