Impact of pharmacy services on initial clinical outcomes and medication adherence among veterans with uncontrolled diabetes.

BACKGROUND: Diabetes remains a growing public health threat but evidence supports the role that pharmacists can play in improving diabetes medication use and outcomes. To improve the quality of care, the Veterans Health Administration has widely adopted care models that integrate clinical pharmacists, but more data are needed to interpret the impact of these services. Our objective was to assess clinical pharmacy services' impact on outcomes and oral antidiabetic medication (OAD) use among veterans with uncontrolled diabetes in the first year of therapy. METHODS: This was a retrospective cohort analysis using the Veterans Affairs (VA) Corporate Data Warehouse to identify the first diagnosis of and initiation of OAD therapy for uncomplicated, uncontrolled diabetes (A1C > 7.0%) during 2002-2014. Receipt of clinical pharmacy services was identified using codes within VA electronic health records, and clinical values were obtained at or near the initial fill date and 365 days later. Use of OADs was assessed by proportion of days covered (PDC) for one year following the first filled prescription. Veterans having received clinical pharmacy services were matched 1:1 to those having not seen a clinical pharmacist in the first year of therapy, and generalized linear models assessed changes and differences in outcomes. RESULTS: The analysis included 5749 patients in each cohort. On average, patients saw a clinical pharmacist 2.5 times throughout the first year of OAD therapy. Adherence to OAD medications was higher in veterans having seen a pharmacist (84.3% vs. 82.4%, p < 0.0001) and more such patients achieved a PDC of at least 80% (72.2% vs. 68.2%, p < 0.0001). After one year of OAD therapy, mean change in hemoglobin A1C was greater among those receiving pharmacy services (- 1.5% vs. -1.4%, p < 0.0001). CONCLUSION: Pharmacist participation in diabetes patients' primary care positively affects the multifaceted needs of patients with this condition and comorbid chronic disease.

Evaluation of patient satisfaction with diabetes management provided by clinical pharmacists in the patient-centered medical home.

STUDY OBJECTIVE: The patient-centered medical home (PCMH) model is a multidisciplinary, team-based approach to healthcare that focuses on actively involving the patient in clinical decision making. Multiple studies have demonstrated improved clinical outcomes from utilizing clinical pharmacists in the primary care setting, particularly in management of diabetes. No study has evaluated patient satisfaction with pharmacist in the PCMH model. Our objective was to evaluate patient satisfaction of care received in pharmacist-managed primary care clinics among patients with diabetes mellitus within the PCMH. DESIGN: This study was a single-center, cross-sectional analysis of patients who were seen by a clinical pharmacy specialist (CPS). SETTING: The setting for this study was eight outpatient primary care clinics within a Veterans Affairs healthcare system where diabetes management services were provided by eight CPSs. PATIENTS: A total of 1,468 patients with a hemoglobin A1c >7.0 % who were seen in clinic by a CPS at the primary care clinics between 1 October 2008 and 1 April 2012 were mailed the Modified Diabetes Disease State Management Questionnaire (DDSM-QM). The DDSM-QM was a 15-item questionnaire that assessed overall patient satisfaction with pharmacist care, as well as patient satisfaction within three major domains: 'service,' 'self-management,' and 'knowledge'. MEASUREMENTS AND MAIN RESULTS: A response rate of 42.7 % was attained, with 627 patients consenting to participate by completing and returning the self-administered questionnaire. The mean overall satisfaction score was 90.6 ± 10.6 % (mean ± standard deviation). Mean percentage scores within the 'service,' 'knowledge,' and 'self-management' domains were 92.0 ± 10.8, 89.7 ± 11.3, and 89.2 ± 12.0 %, respectively. CONCLUSION: Patients with diabetes seen by a CPS within the PCMH model were very satisfied with the care they received overall.