A study led by USC School of Pharmacy faculty members Kathleen Johnson, Steven Chen, Mel Baron and Jeffrey McCombs demonstrates that integrating pharmacist-led management of type 2 diabetes into safety net clinics with the patient-centered medical home model improves clinical outcomes.
The study appeared in the December issue of The Annals of Pharmacotherapy, a PubMed journal. Other authors on the study included Paul Gregerson, chief medical officer at the JWCH Institute; I-Ning Cheng, a clinical pharmacy specialist at HealthCare Partners; and Carla Blieden, a clinical pharmacist; and Mimi Lou, project manager, both at the USC School of Pharmacy.
“While several previous studies have acknowledged the expanded role of pharmacist services in the U.S. health care system,” said Johnson, holder of the William A. and Josephine A. Heeres Endowed Chair in Community Pharmacy, “most lack comparison groups to evaluate outcomes of these clinical services. Our study evaluates the outcomes of patients with type 2 diabetes who received care from pharmacists in safety net clinic settings, compared to the outcomes of patients in clinics receiving ‘usual care’ that is without a clinical pharmacist on the team.”
The study evaluated changes in A1C levels, a test that measures an individual’s average blood glucose level over a two- or three-month period. The test, which provides an indication of how well a treatment plan is working for the patient, is the current standard for correlating blood glucose control with risk of diabetes-related complications. Patients were included in the study if they had poor diabetes control, defined as an A1C level greater than 9 percent.
The study found that patients who received care that included pharmacists had adjusted A1C levels reduced, on average, by 1.38 percentage points compared to those without pharmacist involvement in treatment. This is a clinically meaningful improvement, making it three times as likely for patients to achieve an A1C level of less than 7 percent, the typical treatment goal in the study.
Landmark studies also have shown that a 1 percentage point decline in A1C reduces the risk of microvascular complications, myocardial infarction and diabetes-related death over a 10-year period.
Approximately 44 million people in the United States are uninsured, low-income underinsured, Medicaid beneficiaries or patients with special health care needs who do not receive regular medical care, and these are the patients that often utilize safety net clinics. Improving outcomes in this setting holds significant implications on a national scale.
“These findings provide important information for our policymakers as they reevaluate our health care system,” Chen said. “Patients cared for in safety net clinics often rely on emergency rooms when complications occur, and many patients use emergency rooms as their source of primary care, so improving their outcomes in patient-centered medical homes will ultimately save health care dollars and improve overall quality of life.”
Diabetes patients in particular risk experiencing medical complications if their disease is not managed properly. These complications include cardiovascular disease, which accounts for the majority of diabetes-related mortality, nephropathy and end-stage renal disease, retinopathy and neuropathy.
Patient self-management skills are essential to the success of diabetes management, and these skills typically were taught by a pharmacist in the study’s clinic settings. In addition, the pharmacists review medical, laboratory and medication histories, evaluate and modify drug therapy under an established protocol, order routine laboratory tests, monitor adherence to drug therapy regimens and provide follow-up care. Pharmacists work with all members of the patient-centered medical home; when appropriate, referrals are made to physicians, social workers and mental health professionals.
“Our study shows that when a pharmacist is on the team, the outcomes are better,” Gregerson said. “Pharmacists fulfill the pivotal role of medication expert on today’s health care team.”
Studies like this one provide evidence that the expanded role of the pharmacist can have a positive impact on the health outcomes of at-risk patients.
The USC School of Pharmacy currently provides clinical pharmacy services to 12 safety net clinics in the Los Angeles area.
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