• Diabetes Mellitus
• Diabetes & Endocrinology Clinical Trials Diabetes & Metabolic Syndrome

• Diabetes Mellitus
• Diabetes & Endocrinology Clinical Trials
• Endocrinology
• Diabetes & Metabolic Syndrome

There are currently an estimated 56 million patients in the United States who do not have adequate access to primary health care. As the number of patients with diabetes increases, this number is expected to increase. Team-based care has proven valuable for patients with diabetes and can extend health care to more people through nonphysician providers. Pharmacists play an essential role in team-based patient care because of patients' reliance on medications to reduce disease-related complications. It is possible that expanding the role of pharmacists in patient care could improve patient outcomes. In Virginia, pharmacist-physician collaborations were expanded in 2013 to include initiation, modification, continuation, and discontinuation of drug therapy.

Evan M. Sisson, PharmD, MHA, Virginia Commonwealth University, Richmond, Virginia, USA, presented data from an ongoing evaluation of a collaborative practice model among physicians and pharmacists that provides care for patients with chronic disease in an urban safety net clinic. The population in this clinic faces significant barriers to care. Pharmacists provide 20 hours per week of comprehensive management of medications, which is about 70% of the overall care at this clinic. The care model is illustrated in Figure 1.

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Figure 1.

Collaborative Care Model

CHW=community health worker; LPN=licensed practical nurse; MA=medical assistant; MD=medical doctor; NP=nurse practitioner; RD=registered dietitian. Reproduced with permission from D Dixon, PharmD, MHA, CDE.

This analysis included 178 patients with ≥ 2 pharmacist visits during 2009, who were followed from 2010 to 2012. The mean age was 51.5 years (range, 18 to 65); 63% were women, 75% were black, and 19% were white. All patients had a medical history of hypertension (HTN); 33.7% had a history of hyperlipidemia; and 18.5% had diabetes.

Mean blood pressure (BP) was reduced from 156/97 mm Hg at the initial visit to 131/83 mm Hg at the end of follow-up. Mean non-HDL cholesterol was reduced from 154 mg/dL to 129 mg/dL.

Patients with stage 2 hypertension (n = 84) and all other patients (n = 94) had a similar mean number of visits to the pharmacist (7.5 vs 7.0) and to physicians (1.2 vs 1.1) between 2010 and 2012. However, during this period, patients with diabetes had more visits to the pharmacist compared with all other patients (12.4 vs 6.1). Among patients with diabetes, the number of visits to physicians was slightly fewer than those to pharmacists (1.0 vs 1.2).

During follow-up, the proportion of patients with diabetes with levels of HbA_1c < 7% increased from 33% to 70% (p < .05). HbA_1c decreased from a mean of 8.4% to 6.4% in 2012 (p = .0008). The improvement in HbA_1c levels < 7% and the reduction in mean HbA1c levels occurred by 2010 and were maintained throughout the observation period. Initially, only 9% of patients with diabetes had BP levels < 130/80 mm Hg, and this increased to 24% of patients by 2010 and was maintained at 2012 (p = .18).

The collaborative practice model between pharmacists and primary care practitioners was able to achieve and maintain positive health outcomes. BP decreased among patients with HTN. Among patients with diabetes, there was a significant reduction in HbA1c levels and a nonsignificant reduction in BP. This model warrants further study in other settings but may offer one way in which to increase access to high-quality health care.

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