Effect of the pharmacist-managed cardiovascular risk reduction services on diabetic retinopathy outcome measures
Background: Diabetic retinopathy (DR) is a progressive, sight-threatening long-term complication of diabetes. Diabetes disease management reduces the risk of developing or progression to a severe form of DR. However, there are no reports of the potential role of pharmacists in DR progression.
Objective: For this study, we performed a retrospective data analysis of patients with diabetes seen at cardiovascular risk reduction services provided by pharmacists with an objective to determine the potential role of pharmacists in the DR progression. These services involve pharmacists working in collaborative drug therapy management (CDTM), using a collaborative practice agreement (CPA) with primary care physicians.
Methods: Patient records and ophthalmological notes were collected for 317 individuals seen by the pharmacists (intervention group) and 320 individuals seen only by a physician (control).
Results: Statistical analysis was performed on 148 individuals in an intervention group and 120 individuals in the control group for which complete records were available. Retinopathy progression remained stable in 89.6 % of individuals in the intervention group compared to 87.9% in the control group. Moreover, the relative risk of retinopathy progressing to a severe form was 1.17 for the control group compared the intervention group.
Conclusions: Our studies provide a proof-of-concept that pharmacists-managed care possesses a potential role in protection from DR, and paves a way for future pharmacists managed care with an emphasis on reducing diabetic complications.
Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Popul Health Manag. 2017;20(1):6-12. https://dx.doi.org/10.1089/pop.2015.0181
Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, Ferris FL 3rd, Klein R; American Diabetes Association. Diabetic retinopathy. Diabetes Care. 2003;26(Suppl 1):S99-S102. https://dx.doi.org/10.2337/diacare.26.2007.S99
Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, Gregg EW, Albright AL, Klein BE, Klein R.Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304(6):649-656. https://dx.doi.org/10.1001/jama.2010.1111
Wong TY, Mwamburi M, Klein R, Larsen M, Flynn H, Hernandez-Medina M, Ranganathan G, Wirostko B, Pleil A, Mitchell P. Rates of progression in diabetic retinopathy during different time periods: a systematic review and meta-analysis. Diabetes Care. 2009 Dec;32(12):2307-2313. https://dx.doi.org/10.2337/dc09-0615
Ophthalmology AAoO-ICo. International Clinical Diabetic Retinopathy Disease Severity Scale, Detailed Table International Council of Ophthalmology Available at: http://www.icoph.org/resources/45/International-Clinical-Diabetic-Retinopathy-Disease-Severity-Scale-Detailed-Table-.html (accessed Jul 24, 2018).
Aiello LP, Gardner TW, King GL, Blankenship G, Cavallerano JD, Ferris FL 3rd, Klein R. Diabetic retinopathy. Diabetes Care. 1998;21(1):143-156.
Atchison E, Barkmeier A. The role of systemic risk factors in diabetic retinopathy. Curr Ophthalmol Rep. 2016;4(2):84-89. https://dx.doi.org/10.1007/s40135-016-0098-8
Konstantinidis L, Carron T, de Ancos E, Chinet L, Hagon-Traub I, Zuercher E, Peytremann-Bridevaux I. Awareness and practices regarding eye diseases among patients with diabetes: a cross sectional analysis of the CoDiab-VD cohort. BMC Endocr Disord. 2017;17(1):56. https://dx.doi.org/10.1186/s12902-017-0206-2
Lindenmeyer A, Sturt JA, Hipwell A, Stratton IM, Al-Athamneh N, Gadsby R, O'Hare JP, Scanlon PH. Influence of primary care practices on patients' uptake of diabetic retinopathy screening: a qualitative case study. Br J Gen Pract. 2014;64(625):e484-e492. https://dx.doi.org/10.3399/bjgp14X680965
van Eijk KN, Blom JW, Gussekloo J, Polak BC, Groeneveld Y. Diabetic retinopathy screening in patients with diabetes mellitus in primary care: Incentives and barriers to screening attendance. Diabetes Res Clin Pract. 2012;96(1):10-16. https://dx.doi.org/10.1016/j.diabres.2011.11.003
Ashman JJ, Talwalkar A, Taylor SA. Age differences in visits to office-based physicians by patients with diabetes: United States, 2010. NCHS Data Brief. 2014 Jul;(161):1-8.
Hartnett ME, Key IJ, Loyacano NM, Horswell RL, Desalvo KB. Perceived barriers to diabetic eye care: qualitative study of patients and physicians. Arch Ophthalmol. 2005 Mar;123(3):387-391. https://dx.doi.org/10.1001/archopht.123.3.387
Saadine JB, Fong DS, Yao J. Factors associated with follow-up eye examinations among persons with diabetes. Retina. 2008;28(2):195-200. https://dx.doi.org/10.1097/IAE.0b013e318115169a
Ellish NJ, Royak-Schaler R, Passmore SR, Higginbotham EJ. Knowledge, attitudes, and beliefs about dilated eye examinations among African-Americans. Invest Ophthalmol Vis Sci. 2007;48(5):1989-1994. https://dx.doi.org/10.1167/iovs.06-0934
Rushforth B, McCrorie C, Glidewell L, Midgley E, Foy R. Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review. Br J Gen Pract. 2016;66(643):e114-e127. https://dx.doi.org/10.3399/bjgp16X683509
Lewis K, Patel D, Yorston D, Charteris D. A qualitative study in the United Kingdom of factors influencing attendance by patients with diabetes at ophthalmic outpatient clinics. Ophthalmic Epidemiol. 2007;14(6):375-380. https://dx.doi.org/10.1080/09286580701375195
Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, Graff Zivin J, Abraham I, Palmer J, Martin JR, Kramer SS, Wunz T. US pharmacists' effect as team members on patient care: systematic review and meta-analyses. Med Care. 2010;48(10):923-933. https://dx.doi.org/10.1097/MLR.0b013e3181e57962
Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta-analysis in diabetes management. Ann Pharmacother. 2007;41(10):1569-1582. https://dx.doi.org/10.1345/aph.1K151
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 (Wash). 2003;43(2):173-184. https://dx.doi.org/10.1331/108658003321480713
Pringle JL, Boyer A, Conklin MH, McCullough JW, Aldridge A. The Pennsylvania Project: pharmacist intervention improved medication adherence and reduced health care costs. Health Aff (Millwood). 2014;33(8):1444-1452. https://dx.doi.org/10.1377/hlthaff.2013.1398
Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract. 2017;6:37-46.
Santschi V, Chiolero A, Paradis G, Colosimo AL, Burnand B. Pharmacist interventions to improve cardiovascular disease risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Care. 2012;35(12):2706-2717. https://dx.doi.org/10.2337/dc12-0369
Klein R, Marino EK, Kuller LH, Polak JF, Tracy RP, Gottdiener JS, Burke GL, Hubbard LD, Boineau R. The relation of atherosclerotic cardiovascular disease to retinopathy in people with diabetes in the Cardiovascular Health Study. Br J Ophthalmol. 2002;86(1):84-90. https://dx.doi.org/10.1136/bjo.86.1.84
Shieh G. A comparison of two approaches for power and sample size calculations in logistic regression models. Communications in Statistics Simulation and Computation. 2000;29(3):763-791. https://dx.doi.org/10.1080/03610910008813639
O'Brien RG SG. A simpler method to compute power for likelihood ratio tests in generalized linear models. 1998 Joint Statistical Meetings 1998; Dallas.
Nau D. Effects of a community pharmacist-based diabetes patient-management program on intermediate clinical outcome measures. J Manag Care Spec Pharm. 2002;8(1):48-53. https://dx.doi.org/10.18553/jmcp.2002.8.1.48
Willens D, Cripps R, Wilson A, Wolff K, Rothman R. Interdisciplinary team care for diabetic patients by primary care physicians, advanced practice nurses, and clinical pharmacists. Clinical Diabetes. 2011;29(2):60-68. https://dx.doi.org/10.2337/diaclin.29.2.60
Rothman RL, So SA, Shin J, Malone RM, Bryant B, Dewalt DA, Pignone MP, Dittus RS. Labor characteristics and program costs of a successful diabetes disease management program. Am J Manag Care. May 2006;12(5):277-283.
Aldebasi YH, Reddy PR, Nair VG, Ahmed MI. Screening for diabetic retinopathy: the optometrist's perspective. Clin Optom. 2015;7:1-14. https://dx.doi.org/10.2147/OPTO.S36603
American Diabetes Association Clinical Practice Recommendations 2001. Diabetes Care. 2001;24(Suppl 1):S1-133.
The authors hereby transfer, assign or otherwise convey to Pharmacy Practice (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print or epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final PDFs of their respective articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.