Implementation of a pharmacist-run telephonic insulin titration service.

OBJECTIVES: To describe an insulin titration-by-phone service conducted by pharmacists and to discuss the effects of this service on patient care and outcomes in the first year of its existence.
SETTING: An academic family medicine department in which pharmacists practice in nondistributory roles, from March 2009 through March 2010. PRACTICE DESCRIPTION: Pharmacy services within the department include a chronic disease medication therapy management clinic as well as consultation in various other primary care and specialty clinics. Fourth-year student pharmacists complete advanced pharmacy practice experiences at this site as well. PRACTICE INNOVATION: Based upon a need identified by department providers (physicians and physician assistants), an insulin titration-by-phone service was implemented by two faculty pharmacists. Patients were referred into this service by their primary care provider (PCP) and were called by one of the pharmacists on a regular basis. Pharmacist recommendations for insulin dose adjustments were made based on patient reported self-monitored glucose values. PCP approved recommendations and the patient was notified of changes. MAIN OUTCOME MEASURE: Decrease in glycosylated hemoglobin (A1C ) within 9 months of referral to the service when compared with baseline.
RESULTS: Analysis included 76 patients. The mean decrease in A1C was 1.55% (SD 2.31; P <0.001). The largest decrease in A1C (1.4%) was seen in the first 3 months after referral. Seven patients achieved an A1C ≤7% ( P = 0.007). Forty-one patients had a decrease in A1C of at least 1% during the first 9 months after their referral ( P <0.001).
CONCLUSION: The implementation of a pharmacist-run insulin titration-by-phone service resulted in improvements in A1C that were most pronounced in the first 3 months after referral.