Impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization.

PURPOSE: The impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization is described. METHODS: Six hospitals from the Carilion Clinic health system in southwest Virginia, along with 22 patient-centered medical home (PCMH) practices affiliated with Carilion Clinic, participated in this project. Eligibility criteria included documented diagnosis of 2 or more of the 7 targeted chronic conditions (congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and depression), prescriptions for 4 or more medications, and having a primary care physician in the Carilion Clinic health system. A total of 2,480 evaluable patients were included in both the collaborative care group and the usual care group. The primary clinical outcomes measured were the absolute change in values associated with diabetes mellitus, hypertension, and hyperlipidemia management from baseline within and between the collaborative care and usual care groups. RESULTS: Significant improvements (p < 0.01) in glycosylated hemoglobin, blood pressure, low-density-lipoprotein cholesterol, and total cholesterol were observed in the collaborative care group compared with the usual care group. Hospitalizations declined significantly in the collaborative care group (23.4%), yielding an estimated cost savings of $2,619 per patient. The return on investment (net savings divided by program cost) was 504%. CONCLUSION: Inclusion of clinical pharmacists in this physician-pharmacist collaborative care-based PCMH model was associated with significant improvements in patients' medication-related clinical health outcomes and a reduction in hospitalizations.

Effect of injectable and oral contraceptives on glucose and insulin levels.

OBJECTIVE: To estimate the effect of using two methods of hormonal contraceptives (depot medroxyprogesterone acetate) or an oral contraceptive pill (OCP) containing 20 micrograms ethinyl estradiol and 0.15 mg desogestrel) on serum glucose and insulin levels, as well as predictors of any observed changes. METHODS: Fasting glucose and insulin levels were measured on 703 white, African-American, and Hispanic women using depot medroxyprogesterone acetate, OCPs, or nonhormonal birth control at baseline and every 6 months thereafter for 3 years. Participants also completed questionnaires containing demographic and behavioral measures every 6 months. Mixed-model regression analyses were used to estimate changes over time in glucose and insulin levels by method, along with their predictors. RESULTS: Depot medroxyprogesterone acetate, but not OCP, users experienced slightly greater increases in glucose and insulin as compared with nonhormonal users (P<.001). Among depot medroxyprogesterone acetate users, a small but steady increase in serum glucose levels (2 mg/dL at 6 months to 3 mg/dL at 30 months) was observed throughout the first 30 months, but it leveled off after that. In contrast, serum insulin levels showed an upward (3 units at 6 months to 4 units at 18 months) trend for the first 18 months of depot medroxyprogesterone acetate use and then remained almost flat thereafter. Elevation of insulin and glucose levels was slightly more pronounced in obese and overweight depot medroxyprogesterone acetate users than those who were normal weight. CONCLUSION: Use of depot medroxyprogesterone acetate, but not very-low-dose OCPs containing desogestrel, can lead to slightly higher fasting glucose and insulin levels. LEVEL OF EVIDENCE: II.