Impact of Pharmacist-Led Drug Therapy Management Services on HbA 1c Values in a Predominantly Hispanic Population Visiting an Outpatient Endocrinology Clinic

Abstract

Purpose

To assess the impact pharmacists have on improving glycemic control among predominantly Hispanic diabetic patients visiting an endocrinology clinic in South Texas. Pharmacists were recently integrated into this clinic to be part of a collaborative team.

Methods

This study follows a retrospective cohort design. All patients received diabetic care from endocrinologists, and some received pharmacist-led drug therapy management (PDTM). Patients with ≥1 PDTM were categorized as the intervention group and those without PDTM as the standard of care (SOC) group. The outcome variables were the mean absolute change in glycosylated hemoglobin (HbA_1c) from baseline and the proportion of patients at goal HbA_1c (<7%) postintervention.

Results

Data were collected from 222 patients (n = 120 SOC patients, n = 102 PDTM patients). The mean age was 61 ± 14 years, 136 (61%) were female, and 197 (89%) were Hispanic. The mean absolute change in HbA_1c was −1.3%. In the adjusted model, the mean absolute change in HbA_1c in the PDTM compared to the SOC group was not significant (−0.1% ± 0.2%; P < .74), and concurrent interventions from registered dieticians (RDs) and licensed professional counselors (LPC) were identified as effect modifiers of the association. The stratum specific analysis identified the greatest decrease in HbA_1c when the three interventions (ie, PDTM, RD, and LPC) coincided (−1.0% ± 0.3%; P < .01). Postintervention, 25% of those who received PDTM achieved an HbA_1c<7% as compared to 19% in the SOC group.

Conclusion

The clinical importance of pharmacists is enhanced when integrated with behavioral modifying programs to achieve additional improvement in HbA_1c.