PRP175: The Impact of a Clinical Pharmacist on Outcomes for Type 2 Diabetes in a Community Based Clinic
Thomas Ludden, PhD; Jeremy Thomas, MSW; Andrea DeSantis DO, DO, FAAFP; Hazel Tapp, PhD
Context: Type 2 diabetes is a complex disease with multiple adverse outcomes if not managed effectively. The Clinical Pharmacist Practitioner (CPP) can be an integral part of the care team by spending longer amounts of time educating patients about their medications, avoidance of medication interactions and tailoring therapy to meet the specific needs of an individual patient. Objective: Here we hypothesized that patients receiving CPP care will achieve and maintain clinically significant glycosylated hemoglobin A1c (HbA1c) improvements compared to an unassigned control while controlling for adherence to prescribed medications. Study Design and Analysis: We retrospectively examined all Type 2 diabetic patients seen within a 5-year time with a HbA1c greater than 9.0 and compared those who had a visit or series of visits with an on-site clinical pharmacist (intervention group) with those who did not (control group). All patients received routine care for diabetes management from their primary care doctor or advanced practice provider (APP). Adherence to medication was evaluated from chart reviews. Setting: Atrium Health is a large health care system located in the Southeast with approximately 12 million patient encounters annually. Population Studied: Adult Type 2 diabetic patients between the ages of 18 and 85 cared for at a large urban family medicine clinic within Atrium Health, Charlotte, NC. Outcome Measures: A power analysis indicated 126 patients (63 in the control group and 63 in the intervention group) would detect a clinically significant change of 0.5 in HbA1c within a 6 to 18- month time frame. Results: 126 patients have been identified and chart reviews are underway. Both the change in HbA1c readings and the number of CPP visits required to meet the HbA1c goal will be captured. Expected Outcomes: Patients with logistical, cultural, and financial obstacles to care are at the greatest risk for poor health outcomes. Having consistent and timely access to high quality, full scope of practice primary care such as through involving a CPP is necessary to mitigate disparities by maximizing patient engagement and avoiding unnecessary complications, subspecialty referrals and overuse of inpatient hospital and emergency room care.