Impact of Physician-Pharmacist Covisits at a Primary Care Clinic in Patients With Uncontrolled Diabetes.

PURPOSE: A popular method for enhancing medication management within a patient-centered medical home (PCMH) is the physician-pharmacist collaborative management (PPCM) model. To improve efficiency of health-care delivery within 4 federally qualified health centers (FQHCs), the PPCM model was implemented through coordinated physician-pharmacist covisits. OBJECTIVE: To evaluate the impact of physician-pharmacist covisits on clinical outcomes among patients with uncontrolled diabetes. METHODOLOGY: This was a retrospective multicenter cohort study including adults (≥18 years old) with uncontrolled type 1 or type 2 diabetes (hemoglobin A1c [HbA1c] ≥ 8 %) who had at least one covisit between January 1, 2013, and October 1, 2016. The primary clinical metric was mean change in HbA1c from baseline to follow-up. Secondary outcomes included adherence to select American Diabetes Association (ADA) Standards of Medical Care. RESULTS: A total of 106 patients were included in this analysis. Patients who were managed in the PPCM model experienced a significant decrease in mean change in HbA1c from baseline to follow-up (-1.75 [2.63], P < .001). There was no significant difference in the proportion of patients receiving recommended vaccinations or cardiovascular (CV) risk reduction medications. CONCLUSION: The results suggest that physician-pharmacist covisits may improve glucose control in patients with uncontrolled diabetes.

Adherence to the 2013 Blood Cholesterol Guidelines in Patients With Diabetes at a PCMH: Comparison of Physician Only and Combination Physician/Pharmacist Visits.

PURPOSE: The purpose of this study is to assess adherence to the 2013 blood cholesterol guideline in a population with diabetes based on the atherosclerotic cardiovascular (ASCVD) risk. METHODS: Patients with diabetes were assessed to see whether they received the appropriate intensity statin therapy via chart review. Patients seen by a physician or pharmacist at CommUnityCare, a PCMH, from December 2013 to October 2014 were included in this retrospective study. The ASCVD risks were calculated to determine if the patients received appropriate intensity statin. RESULTS: A total of 583 patients met the inclusion criteria; there were 475 in the physician only group and 108 with additional pharmacist visits. Statin therapy was prescribed in 71% of patients in the physician group and 88% of patients in the pharmacist/physician group. The appropriate intensity statin was prescribed in 32% of patients in the physician group and 35% of patients in the pharmacist/physician group. The appropriate intensity statin in statin naïve patients was prescribed in 45% of the physician group and 50% of patients in the pharmacist/physician group. CONCLUSION: The proportion of patients prescribed an appropriate intensity statin did not differ between patients managed by physicians alone compared to those managed by pharmacists and physicians. Overall adherence to the 2013 blood cholesterol guidelines was 33%, and this measure can be used as a baseline assessment of current adherence with the guidelines.

Screening for diabetes in patients receiving second-generation atypical antipsychotics.

PURPOSE: Results of a study to assess adherence with a consensus statement for diabetes screening in patients receiving atypical antipsychotics and to evaluate the role of pharmacists in a patient-centered medical home in improving guideline adherence are presented. SUMMARY: For patients prescribed atypical antipsychotics, records were reviewed for glycosylated hemoglobin (HbA1c) testing within the past 12 months. If no HbA1c results were found within that time frame, physicians were sent an alert in the patient's electronic medical record requesting an HbA1c order. Patient medical records were reviewed to analyze the number of HbA1c orders before and after pharmacist intervention. Prior to pharmacist intervention, 17 of 120 (14%) patients were screened with HbA1c. As a result of pharmacist intervention, 86 alerts were sent to physicians to order an HbA1c level, 24 (28%) of which included an order for an HbA1c level. Eleven of 24 (46%) HbA1c test results were collected during study follow-up, and one prediabetic patient was identified. CONCLUSION: After pharmacist intervention, a greater number of patients receiving atypical antipsychotic medications had HbA1c levels monitored for evidence of type 2 diabetes.