Main Article Content
Poverty, Homeless Persons, Ambulatory Care, Medication Therapy Management, Pharmacists, United States
Objectives: Pharmacist-managed collaborative services in a family practice setting are described, and diabetes and hypertension outcomes are assessed.
Methods: Pharmacist-managed clinics, pharmacotherapy consultations, and drug information services are provided for a medically underserved, predominantly African American population. A pharmacy residency director, an ambulatory care pharmacy resident and three PharmD candidate student pharmacists work directly with physicians, nurse practitioners, nurses, and social workers to form an interdisciplinary health care team. Providers utilize pharmacy services through consultations and referrals. Collaboration outcomes were evaluated in twenty-two patients with diabetes and thirty hypertensive patients. Patients were retrospectively followed throughout their history with pharmacy service. Hemoglobin A1c (A1C) was tracked before referral to pharmacy services, 3 to 6 months after, and as the most current measure after at least 6 months. Blood pressure (BP) was observed before pharmacy involvement, 2 to 4 months later, and then currently for at least 4 months with the service. The mean of the most current markers was calculated, and the percent of patients at their goal marker was compared to national averages.
Results: Fifty percent of pharmacy service patients met the American Diabetes Association hemoglobin A1c goal of less than 7% in our evaluation compared to the national mean of 49.8% overall and 44% in African Americans. Thirty percent of patients were at their BP goal while 33.1% of patients without diabetes and 33.2% of patients with diabetes nationally are at goal.
Conclusion: The medically underserved patients under the care of pharmacy services achieved a higher percentage at their A1C goal than the national mean. The percentage of patients who achieved their BP goals was comparable to the national average. Increasing utilization of pharmacy services in the family practice setting allows for pharmacists and providers to form a trusted relationship while providing enhanced care and potentially improved outcomes for patients.
2. Anaya JP, Rivera JO, Lawson K, Garcia J, Luna J, Ortiz M. Evaluation of pharmacist-managed diabetes mellitus under a collaborative drug therapy agreement. Am J Health-Syst Pharm. 2008;65:1841-1845.
3. Cioffi ST, Caron MF, Kalus JS, Hill P, Buckley TE. Glycosylated hemoglobin, cardiovascular, and renal outcomes in a pharmacist-managed clinic. Ann Pharmacother. 2004;38:771-775.
4. Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173-184.
5. Cranor CW, Christensen DB. The Asheville Project: short-term outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:149-159.
6. Isetts BJ, Brown LM, Schondelmeyer SW, Lenarz LA. Quality Assessment of a Collaborative Approach for Decreasing Drug-Related Morbidity and Achieving Therapeutic Goals. Arch Intern Med. 2003;163:1813-1820.
7. Kiel PJ, McCord AD. Pharmacist impact on clinical outcomes in a diabetes disease management program via collaborative practice. Ann Pharmacother. 2005;39:1828-1832.
8. Knapp KK, Okamoto MP, Black BL. ASHP survey of ambulatory care pharmacy practice in health systems – 2004. Am J Health-Syst Pharm. 2005;62:274-284.
9. Morello CM, Zadvorny EB, Cording MA, Suemoto RT, Skog J, Harari A. Development and clinical outcomes of pharmacist-managed diabetes care clinics. Am J Health-Syst Pharm. 2006;63:1325-1231.
10. Nkansah NT, Brewer JM, Connors R, Shermock KM. Clinical outcomes of patients with diabetes mellitus receiving medication management by pharmacists in an urban private physician practice. Am J Health-Syst Pharm. 2008;65:145-149.
11. Ragucci KR, Fermo JD, Wessell AM, Chumney ECG. Effectiveness of Pharmacist-Administered Diabetes Mellitus Education and Management Services. Pharmacotherapy. 2005;25(12):1809-1816.
12. Till T, Voris J, Horst J. Assessment of clinical pharmacist management of lipid-lowering therapy in the primary care setting. J Manag Care Pharm 2003;9(3):269-273.
13. American Diabetes Association. Standards of medical care in diabetes – 2009. Diabetes Care. 2009;32(Suppl 1):S13-61.
14. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ, and the National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-2572.
15. Resnick HE, Foster GL, Bardsley J, Ratner RE. Achievement of American Diabetes Association clinical practice recommendations among US adults with diabetes, 1999-2002. The National Health and Nutrition Examination Survey. Diabetes Care. 2006;29:531-537.
16. Ong KL, Cheung BMY, Man YB, Lau CP, Lam KSL. Prevalence, Awareness, Treatment, and Control of Hypertension Among United States Adults 1999-2004. Hypertension. 2007;49:69-75.