University:
Boston University
Course:
SPH GH 701 | Global Health Storytelling
Academic year:

2024
Views:

177

Pages:

1
Author:

Kate Schaefer

Impact of clinical pharmacy services on quality care measures for patients with type 2 diabetes mellitus in an outpatient family medicine clinic Background • The Boston Medical Center (BMC) family medicine clinic cares for approximately 900 patients with type 2 diabetes mellitus (T2DM) • Prior to the implementation of a full-time clinical pharmacist, 30% of patients had a hemoglobin A1c above 8% • The family medicine clinic at BMC is recognized as a level 3 certified National Committee for Quality Assurance (NCQA) medical home • Evidence to support the influence of a clinical pharmacist on compliance with standards of care in a PCMH has not been evaluated Objective • Assessed the impact of a clinical pharmacist on care of patients with T2DM in a certified NCQA medical home using disease specific standards Methods Demographics Characteristic Body Mass Index, mean (±SD) Male Gender, n (%) Race, n (%) Caucasian Black Hispanic/Latino Other Smoking Status, n (%) Smoker Family Medicine Visits, mean (±SD) • Observational, single center, retrospective study • Data collected from March 1, 2013 to November 30, 2014 Inclusion Criteria (n=875) • • • Attendance at ≥1 visit in Family Medicine clinic at BMC between 9/1/13 and 8/31/14 Diagnosis of T2DM ≥ 18 years of age Exclusion Criteria (n=539) • A1c <7% (n=291) • Actively followed by endocrinologist for DM (n=38) • Lack of A1c before or after the baseline visit within the study timeframe (n=210) Usual Care (n=226) Referral (n=110) 0 clinical pharmacist visits ≥1 clinical pharmacist visits Outcomes To Be Evaluated Results Primary Outcome Primary outcome: Mean change in hemoglobin A1c Pharmacist Referral (n=110) Usual Care (n=226) p-value 34.3 (±8.2) 32.3 (±7.2) 0.02 63 (57.3) 97 (42.9) 0.01 7 (6.3) 23 (10.2) 0.31 86 (78.2) 161 (71.2) 0.19 6 (5.5) 16 (7.1) 0.65 11 (10.0) 26 (11.5) 0.85 • Statin, ACEI or ARB, Aspirin* • With documentation of pneumococcal vaccination status • With labs obtained: Hemoglobin A1c* • Admitted at BMC or seen in the ED for glycemic control issues *Outcomes are currently being evaluated using the 2013 American Diabetes Association (ADA) Guidelines Discussion • Complicated patients are more likely to be referred for pharmacy care Outcome 21 (19.1) 30 (13.3) 0.19 9.6 (±5.1) 4.2 (±3.1) <0.0001 Change in A1c, mean (±SD) • Higher baseline A1c and BMI Pharmacist Referral (n=110) Usual Care (n=226) p-value -1.3(±2.2) -0.2(±1.4) <0.0001 Secondary Outcomes Outcome Pharmacist Referral (n=110) Usual Care (n=226) p-value A1c <9%, n (%) 63 (57.3) 170 (75.2) 0.001 A1c <7%, n (%) 23 (20.9) 38 (16.8) 0.37 LDL <100 mg/dL, n (%) 53 (48.2) 100 (44.2) 0.56 Blood Pressure <140/80 mmHg, n (%) 44 (40.0) 73 (32.3) 0.18 102 (92.7) 205 (90.7) 0.68 97 (88.2) 164 (72.6) 0.0012 Podiatry 33 (30.0) 32 (14.2) 0.0011 Ophthalmology 59 (53.6) 85 (37.6) 0.0068 Outcome Metrics Process Metrics Lipid Panel obtained Annually, n (%) Urine Albumin obtained Annually, n (%) • Mean change in body mass index (BMI) • Number of patients: • Prescribed appropriate pharmacotherapy: Referrals, n (%) • Referral to a clinical pharmacist for management of patients with T2DM results in a statistically significant decrease in A1c

Impact of Clinical Pharmacy Services on Quality Care Measures for Patients

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