A comparison of clinical pharmacist management of type 2 diabetes versus usual care in a federally qualified health center
Pharm. pract. (Granada, Internet)
; 17(4): 0-0, oct.-dic. 2019. tab, graf
Article
in En
| IBECS
| ID: ibc-191962
Responsible library:
ES1.1
Localization: BNCS
ABSTRACT
BACKGROUND: Clinical pharmacists have demonstrated their ability to improve patient outcomes over usual care for patients with type 2 diabetes and glycemic levels above goal, though reasons for this are not well defined. Numerous medications exist for the management of patients with type 2 diabetes and different patterns of medication use by clinical pharmacists may explain these benefits. OBJECTIVE: The objective of this study was to compare pharmacotherapy approaches to managing patients with uncontrolled type 2 diabetes receiving basal insulin by a clinical pharmacist versus usual care by a physician or advanced practice provider in a federally qualified health center. METHODS: A retrospective cohort study of patients 18 to 85 years old with type 2 diabetes, A1C ≥9%, receiving basal insulin was conducted. Patients were grouped into two cohorts: (1) those who received clinical pharmacist care and (2) those who received usual care from a physician or advanced practice provider. The primary outcome evaluated the proportion of patients treated with the addition of a non-basal insulin medication. Type of medication changes or additions as well as change in A1C and change in weight were also analyzed. Outcomes were evaluated at six months post-index A1C. RESULTS: A total of 202 patients were identified (n=129 in the usual care group and n=73 in the clinical pharmacist group). A non-basal insulin medication was added in 29% of patients receiving usual care versus 41% of patients receiving clinical pharmacist care (adjusted p = 0.040). Usual care providers more frequently added metformin, sulfonylureas and thiazolidinediones, while clinical pharmacists more frequently added prandial insulin, DPP-4 inhibitors, GLP-1 agonists, and SGLT-2 inhibitors. A1C decreased 1.6% in the clinical pharmacist group versus 0.9% in the usual care group (adjusted p = 0.055). No significant change in weight was observed between the clinical pharmacist and usual care group (0.2 kg versus -1.0 kg, respectively; adjusted p = 0.175). CONCLUSIONS: Pharmacotherapy approaches to managing patients with uncontrolled type 2 diabetes varied between clinical pharmacists and other clinician providers. For patients already on basal insulin, clinical pharmacists were more likely to intensify therapy with the addition of non-basal insulin, including more frequent initiation of prandial insulin and by adding newer antihyperglycemic agents
RESUMEN
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Full text:
1
Collection:
06-national
/
ES
Database:
IBECS
Main subject:
Pharmaceutical Services
/
Diabetes Mellitus, Type 2
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Medication Therapy Management
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Hypoglycemic Agents
Limits:
Aged
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Female
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Humans
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Male
Language:
En
Journal:
Pharm. pract. (Granada, Internet)
Year:
2019
Document type:
Article