RESUMO
OBJECTIVES: Recent data have demonstrated benefits of pharmacist-led protocols for chronic disease state management in the primary care setting. Health coaching has also been shown to improve patient outcomes and reduce health care costs. A program was initiated in August 2017 at a rural, free clinic to provide team-based, patient-centered care management through the use of pharmacist-provider collaborative practice and health coaching for patients with chronic diseases such as diabetes, hypertension, and hyperlipidemia. METHODS: After an initial patient examination, physicians could refer patients for management by the pharmacist + health coach team. Patients continued to see their primary care provider at least yearly and as needed. The pharmacist + health coach team provided a protocol-based approach to chronic disease management, as well as health education pertaining to diet and lifestyle recommendations. In-depth medication and disease state education were provided at each visit. Motivational interviewing was also conducted at each visit. Clinical metrics were collected at baseline and analyzed routinely after program initiation, including glycosylated hemoglobin (A1c), blood pressure, and lipids. Primary objectives were to evaluate the program's impact on A1c, blood pressure, and cholesterol outcomes. RESULTS: A total of 95 patients were included in the analysis (A1c n = 37; systolic and diastolic blood pressure n = 47; total cholesterol n = 40; low-density lipoprotein [LDL] cholesterol n = 38; high-density lipoprotein cholesterol n = 40; and triglycerides n = 40). From baseline to 1 year, statistically significant improvements were observed for A1c (mean ± standard deviation, 8.55 ± 2.58 to 7.04 ± 1.12, P < 0.001), systolic blood pressure (136.79 ± 20.04 to 123.15 ± 16.81, P < 0.001), diastolic blood pressure (87.94 ± 12.28 to 78.64 ± 10.98, P < 0.001), total cholesterol (198.25 ± 52.47 to 183.55 ± 47.22, P = 0.014), and LDL cholesterol (115.74 ± 43.56 to 105.92 ± 39.27, P = 0.040). CONCLUSION: A protocol-driven collaborative practice approach to chronic disease management by a clinical pharmacist in conjunction with health coaching by a registered nurse in a low-income, rural, primary care setting improved A1c, blood pressure, total cholesterol, and LDL cholesterol.
