Pharmacist-led diabetes collaborative improves care, costs

Including pharmacists on primary-care patient teams and providing diabetes drug therapy management for patients with sub-optimally controlled diabetes can help improve blood glucose control and reduce cost trends, according to a recent study.

The study, published in the June 2015 issue of the Journal of Managed Care & Specialty Pharmacy by Carrie McAdam-Marx, PhD, RPh, University of Utah, and colleagues, conducted a retrospective cohort study of patients with sub-optimally controlled diabetes treated by providers in community-based, primary-care clinics in the Salt Lake City, Utah, metropolitan area. The study identified blood glucose control outcomes, healthcare utilization, and healthcare costs in patients who received pharmacist-led diabetes drug therapy management. Outcomes in this group were compared to patients with sub-optimally controlled diabetes who were treated by providers at similar primary-care clinics.

However, the comparison clinics did not have a pharmacist providing diabetes drug therapy management. Multivariate regression analyses were also used to help reduce the risk of bias that can occur with observational studies.

“Patients with sub-optimally controlled diabetes whose diabetes medications were managed by a pharmacist, in collaboration with the patient’s doctor, had significant improvement in their blood glucose control,” says McAdam-Marx, an associate professor at the university’s department of pharmacotherapy and Pharmacotherapy Outcomes Research Center. “These patients also had a less substantial increase in their total medical costs during the study period than diabetes comparison patients.” 

McAdam-Marx cited a study in Health Affairs that showed that patients with diabetes, particularly those with diabetes-related complications such as heart disease or kidney disease, have significantly higher healthcare costs than patients without diabetes.

“Improved management of blood glucose through effective drug therapy helps to reduce the risk of complications,” she told Medical Economics. “When pharmacists collaborate with primary-care physicians to manage diabetes medications, patient outcomes can be improved and healthcare costs avoided, which benefits the patient, the payer, and primary-care practices.”

The availability of clinical pharmacy services (CPS) in community-based primary care is not widespread, according to the authors. “One reason is that current fee-for-service models offer limited reimbursement opportunities for clinical pharmacy services in the community setting. Furthermore, data demonstrating the value of CPS in this setting are limited, making it difficult for providers to determine the feasibility and sustainability of incorporating clinical pharmacy services into primary-care practice,” they wrote.