A retrospective observational population-based study to assess the prevalence and burden of illness of type 2 diabetes with an estimated glomerular filtration rate < 90 mL/min/1.73 m2 in Ontario, Canada.

AIM: To better understand the healthcare burden of people with type 2 diabetes (T2D) and estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2 in Ontario, Canada. MATERIALS AND METHODS: We used administrative data to evaluate the prevalence of T2D, eGFR < 90 mL/min/1.73 m2 and adverse cardiovascular co-morbidities in individuals aged ≥ 30 years living in Ontario, Canada. We also examined incremental healthcare costs and healthcare resource utilization (HCRU) for these patients with specific incident cardiovascular and renal outcomes, in comparison with controls without these outcomes. RESULTS: While the prevalence of T2D in the general population aged ≥ 30 years in Ontario increased by 1.8% over a 5-year period (2011-2012 to 2015-2016), the prevalence of eGFR < 90 mL/min/1.73 m2 among people with T2D increased by 35%. In comparison with corresponding controls without these outcomes, the per patient average total costs (Canadian dollars) over a 2-year analysis period were higher for patients with cardiovascular disease/chronic kidney disease related death ($69 827; n = 32 407), doubling of serum creatinine ($52 260; n = 22 825), those who started dialysis ($150 627; n = 3499) or received a kidney transplant ($50 664; n = 651). Similarly, HCRU was significantly greater for patients with these incident outcomes. CONCLUSIONS: This real-world retrospective study highlights an increasing prevalence of T2D, eGFR < 90 mL/min/1.73 m2 , and the substantially higher healthcare costs and HCRU when these patients have adverse cardiovascular and renal outcomes. The existence of such a large economic burden underpins the importance of preventing these diabetes-related complications.

MedIntegrate: Incorporating provincially funded community pharmacist services into an ambulatory internal medicine clinic to enhance medication reconciliation.

BACKGROUND: Medication reconciliation (MR) is associated with reduced discrepancies and adverse events within institutions. In ambulatory care, MR is often considered more challenging due to periodic, brief patient encounters and the involvement of multiple prescribers who lack shared records. MedsCheck, a community pharmacy program in Ontario for patients with diabetes or those taking 3 or more medications, generates a best possible medication history (BPMH) that can serve as a starting point for MR. Our objectives were to develop and evaluate a program to integrate MedsCheck into the workflow of an ambulatory clinic. METHODS: An initiative was implemented within the Complex Care Clinic (CCC), an academic internal medicine clinic at Women's College Hospital (WCH). During booking of their first appointment, patients were encouraged to receive a MedsCheck. A letter was faxed to the patient's preferred community pharmacy with a request to conduct a MedsCheck and send documentation to the clinic. Evaluation included patient and health care provider questionnaires and chart review. RESULTS: Fifty-five of 86 new patients referred to the CCC were eligible for a MedsCheck. Fifty-four patients consented to having their community pharmacy contacted, and documentation was received for 21 (39%) of these reviews. Chart review was conducted for patients who completed the patient feedback questionnaire (n = 32). Community pharmacists reported at least 1 drug therapy problem for 12 (57%) patients with a mean of 2.6 (SD 1.5) per patient. Medical residents reported an estimated mean appointment time savings of 7.9 minutes (SD 2.4). CONCLUSION: The program was feasibly integrated into clinic workflow and shortened the time spent creating BPMHs. This approach could be adopted by other ambulatory care clinics.