Endocrinology/Primary Care Pharmacy Collaboration vs Endocrinology Care Alone in Patients With Type 2 Diabetes and A1c >9.

Background: Type 2 diabetes (T2D) requires close collaboration between patients and their care management team, often including endocrinology. Primary care pharmacist impact on diabetes management in collaboration with endocrinology is not well established. Objective: To assess if pharmacy and endocrinology collaboration results in a greater A1c reduction in patients with T2D vs endocrinology alone. Methods: This retrospective, observational cohort study was conducted in adult outpatients with T2D and baseline A1c >9% who saw endocrinology within 1 year preceding the study period (January 1, 2021 to January 1, 2022). Patients were included if they had a follow-up A1c 6 months (±90 days) from index date and completed at least 1 endocrinology visit during the study period. Patients managed by endocrinology/primary care pharmacist collaboration (Endo/PharmD) were compared with those who received endocrinology care alone (Endo). Primary outcome was change in A1c from baseline to 6 months. Secondary outcomes included total number of completed visits and percentage of patients achieving A1c <6.5%, <7%, <8%, and <9% between groups at 6 months. Results: A total of 418 patients were included (22 Endo/PharmD, 396 Endo). The change in follow-up A1c was not significantly different between groups, -0.481% (standard error [SE] = 0.396); P = 0.6179. Endo/PharmD patients had significantly more provider visits during the study period (5.3 ± 2.3 vs 2.3 ± 1.2; P < 0.001). No significant difference was observed in odds of A1c goal attainment between groups at 6 months. Conclusion and Relevance: Endocrinology/primary care pharmacist collaboration occurred infrequently but was associated with a trend toward greater A1c reduction in patients with T2D and A1c >9%.

Pharmacist involvement in a comprehensive remote monitoring and telemanagement program.

PURPOSE: To describe the role of the pharmacist in and initial outcomes of a remote monitoring and telemanagement program implemented to proactively provide outreach to high-risk patients during the coronavirus disease 2019 (COVID-19) pandemic. SUMMARY: A remote monitoring and telemanagement program was developed at a large, nonprofit, multicenter, academic health system as an innovative way to manage patients at risk for decompensation of their chronic diseases in the midst of the COVID-19 pandemic. The program mobilized an interprofessional workforce including nurses, medical assistants, social workers, virtualists, patient schedulers, and ambulatory care pharmacists. Patient outreach included a combination of telephone calls and digital outreach. The goal was to monitor patients' health status remotely and assess for early signs of decompensation. Pharmacists conducted telephone outreach to answer patients' medication questions and address signs and symptoms of worsening chronic conditions. Pharmacists were able to utilize an existing collaborative practice agreement (CPA) to adjust medication therapy and order laboratory tests as needed for safety and efficacy monitoring. Since the program's inception in April 2020 through January 2021, pharmacists have addressed over 1,600 medication questions or instances of worsening clinical signs and symptoms. CONCLUSION: A comprehensive remote monitoring and telemanagement program utilized a multidisciplinary team to monitor high-risk patients during the COVID-19 pandemic. Pharmacists contributed to chronic disease management via the use of a comprehensive CPA, allowing medications to be started, stopped, or adjusted on the basis of patients' needs, to improve population health management and reduce workload for primary care providers who were addressing new and emerging issues during the pandemic.

Integration of Community Pharmacists in Transition of Care (TOC) Services: Current Trends and Pharmacist Perceptions.

BACKGROUND:: Barriers exist for patients transitioning from one health-care setting to another, or to home, and health-care systems are falling short of meeting patient needs during this time. Community pharmacist incorporation poses a solution to the current communication breakdown and high rates of medication errors during transitions of care (TOC). The purpose of this study was to determine community pharmacists' involvement in and perceptions of TOC services. METHODS:: Cross-sectional study using electronic surveys nationwide to pharmacists employed by a community pharmacy chain. RESULTS:: Of 7236 pharmacists surveyed, 546 (7.5%) responded. Only 33 (6%) pharmacists reported their pharmacy participates in TOC services. Most pharmacists (81.5%) reported receiving discharge medication lists. The most common reported barrier to TOC participation is lack of electronic integration with surrounding hospitals (51.1%). Most pharmacists agreed that (1) it is valuable to receive discharge medication lists (83.3%), (2) receiving discharge medication lists is beneficial for patients' health (89.1%), (3) discharge medication list receipt improves medication safety (88.8%). CONCLUSIONS:: Most pharmacists reported receiving discharge medication lists and reported discharge medication lists are beneficial, but less than half purposefully used medication lists. To close TOC gaps, health-care providers must collaborate to overcome barriers for successful TOC services.