PHS102 - Evaluating Effectiveness And Persistency of A Pharmacist-Led Disease Management Program

Abstract

A mid-sized medical group in Southern California introduced a pharmacist-led disease management program for patients with diabetes. Interventions intended to improve compliance, disease monitoring and patient education in order to improve blood sugar control and reduce disease-related hospitalizations in high-risk patients. This study evaluated the effects of such interventions on participants in the program. Clinical outcomes include glycated hemoglobin (HgbA1C), low-density lipoprotein (LDL), and diastolic and systolic blood pressure (BP). Clinical values were obtained from lab data and claims for participants in the program. We measured changes in clinical outcomes and medical care utilization before and after enrollment in the program. We also followed patients that were discharged from the program after reaching clinical goals to assess the persistency of the intervention on clinical outcomes. Compared to baseline (enrollment), we observed significant reductions 6 months post-enrollment in HgbA1C (10.2% vs. 8.3%, p<0.001) and LDL (93.8mg/dl vs. 80.8mg/dl, p<0.01). Compared to baseline, the percentage of patients with optimal HgbA1C level (<7%) increased from 1.5% to 19.2%; optimal LDL (<100mg/dl) increased from 62.1% to 80.6%. However, there was no statistically significant improvement in in blood pressure control after 6 months. Clinical gains persisted among the subgroup of beneficiaries discharged from the program. Blood sugar (HgbA1C) and lipid levels 6 months after discharge were substantively similar to the levels at discharge. Nonetheless, there was no reduction in hospitalization rates associated with the intervention. A pharmacist-led intervention to improve the management of diabetes and its sequelae had a significant and persistent effect on blood sugar and lipid control, but did not improve hypertension. Initial results of hospitalization data suggest little impact on inpatient utilization.