A comparison of clinical pharmacist management of type 2 diabetes versus usual care in a federally qualified health center
Rhianna M. Fink1, Emanuela V. Mooney2, Joseph J. Saseen3, Sarah J. Billups1
- 1Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, United States.
- 2University of Colorado Health Medical Group, Colorado Springs, CO, United States.
- 3Department of Clinical Pharmacy and Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Received: 10-07-2019; Accepted: 20-10-2019.
Volume 17, Issue 4 · pp. 1618 · PUBLISHED 3 December 2019 · DOI: 10.18549/PharmPract.2019.4.1618
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.
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Fink, R. M., Mooney, E. V., Saseen, J. J., & Billups, S. J. (2019). A comparison of clinical pharmacist management of type 2 diabetes versus usual care in a federally qualified health center. Pharmacy Practice, 17(4), 1618. https://doi.org/10.18549/PharmPract.2019.4.1618