John P Jameson1, Philip J Baty. 1. Ferris State University, Grand Rapids, MI 40503, USA. john@profjameson.com
Abstract
OBJECTIVE: To investigate the effect of pharmacist management of poorly controlled diabetes mellitus in a community-based primary care group. STUDY DESIGN: Randomized controlled trial of pharmacist management of diabetes compared with usual medical care. METHODS:Patients 18 years or older with glycosylated hemoglobin (A1C) levels of 9.0% or higher were enrolled. Patients were randomly assigned to an intervention group (n = 52) or a control group (n = 51). Management in the control group included the use of registries and targeted patient outreach. The intervention group participated in the same outreach program plus medication management, patient education, and disease control by a pharmacist. RESULTS: Nonparametric data showed median A1C decreases of 1.50% for the intervention group and 0.40% for the control group (P = .06). Significantly more patients in the intervention group improved their A1C level by at least 1.0% relative to the control group (67.3% vs 41.2%, P = .02). Most of this benefit was seen for patients of nonwhite race/ethnicity compared with control subjects (56.3% vs 22.7%, P = .03). Male patients showed significantly greater benefit as well, with a median A1C decrease of 1.90% vs 0.15% for controls (P = .03). CONCLUSIONS: Patients with poorly controlled diabetes improved A1C levels significantly when pharmacist management was added to an aggressive organizational diabetes management program. Our results suggest that clinically trained pharmacists can help primary care providers improve diabetes management, especially among male patients and among patients of nonwhite race/ethnicity.
RCT Entities:
OBJECTIVE: To investigate the effect of pharmacist management of poorly controlled diabetes mellitus in a community-based primary care group. STUDY DESIGN: Randomized controlled trial of pharmacist management of diabetes compared with usual medical care. METHODS:Patients 18 years or older with glycosylated hemoglobin (A1C) levels of 9.0% or higher were enrolled. Patients were randomly assigned to an intervention group (n = 52) or a control group (n = 51). Management in the control group included the use of registries and targeted patient outreach. The intervention group participated in the same outreach program plus medication management, patient education, and disease control by a pharmacist. RESULTS: Nonparametric data showed median A1C decreases of 1.50% for the intervention group and 0.40% for the control group (P = .06). Significantly more patients in the intervention group improved their A1C level by at least 1.0% relative to the control group (67.3% vs 41.2%, P = .02). Most of this benefit was seen for patients of nonwhite race/ethnicity compared with control subjects (56.3% vs 22.7%, P = .03). Male patients showed significantly greater benefit as well, with a median A1C decrease of 1.90% vs 0.15% for controls (P = .03). CONCLUSIONS:Patients with poorly controlled diabetes improved A1C levels significantly when pharmacist management was added to an aggressive organizational diabetes management program. Our results suggest that clinically trained pharmacists can help primary care providers improve diabetes management, especially among male patients and among patients of nonwhite race/ethnicity.
Authors: Martin Fortin; Maud-Christine Chouinard; Marie-France Dubois; Martin Bélanger; José Almirall; Tarek Bouhali; Maxime Sasseville Journal: CMAJ Open Date: 2016-10-12