Candis M Morello1, Melissa L D Christopher2, Linda Ortega3, John Khoan4, Taylor Rotunno4, Steven V Edelman5, Robert R Henry5, Jan D Hirsch5. 1. UC San Diego, La Jolla, CA, USA Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA candismorello@ucsd.edu. 2. Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA Academic Detailing for VACO Pharmacy Benefits Management, San Diego, CA, USA. 3. UC San Diego, La Jolla, CA, USA Rite Aid in Ontario, CA, USA. 4. UC San Diego, La Jolla, CA, USA. 5. UC San Diego, La Jolla, CA, USA Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA.
Abstract
BACKGROUND: No previous studies exist examining the impact of a short-term pharmacist-endocrinologist collaborative practice model on glycemic control in complex patients. OBJECTIVE: Evaluate outcomes associated with a PharmD-Endocrinologist Diabetes Intense Medical Management (DIMM) "tune up" clinic for complex patients. METHODS: A retrospective cohort study of 99 patients referred to DIMM clinic versus a comparator group of 56 primary care provider (PCP) patients meeting the same criteria (adult type 2 diabetes patients, glycosylated hemoglobin [A1C] ≥ 8%, follow-up visit within 6 months) in a Veterans Affairs Medical Center. DIMM clinic used a short-term model that coupled personalized clinical care with real-time, patient-specific diabetes education during two to four 60-minute visits over 6 months. PCP patients received usual care. Primary outcome was mean A1C change after 6 months. Secondary measures included fasting blood glucose, lipids, blood pressure, weight, body mass index, and percentage of patients meeting goals. RESULTS: Patients in each group had an average of 8 and were taking 12 to 14 medications daily. Mean A1C (%) improvement in DIMM group was significantly greater at 6 months (-2.4 [SD = 2.1] vs -0.8 [SD = 1.7]; P < 0.001), than PCP group. Percentage meeting A1C goal levels (<7%, <8%, and <9%) was significantly greater at 3 and 6 months compared with baseline in the DIMM group (P < 0.001) versus (only <8%) at 3 and 6 months compared with baseline in PCP group. CONCLUSIONS: The DIMM clinic "tune up" model demonstrates a successful collaborative practice which helped complex diabetes patients achieve glycemic control in a 6-month period.
BACKGROUND: No previous studies exist examining the impact of a short-term pharmacist-endocrinologist collaborative practice model on glycemic control in complex patients. OBJECTIVE: Evaluate outcomes associated with a PharmD-Endocrinologist Diabetes Intense Medical Management (DIMM) "tune up" clinic for complex patients. METHODS: A retrospective cohort study of 99 patients referred to DIMM clinic versus a comparator group of 56 primary care provider (PCP) patients meeting the same criteria (adult type 2 diabetespatients, glycosylated hemoglobin [A1C] ≥ 8%, follow-up visit within 6 months) in a Veterans Affairs Medical Center. DIMM clinic used a short-term model that coupled personalized clinical care with real-time, patient-specific diabetes education during two to four 60-minute visits over 6 months. PCPpatients received usual care. Primary outcome was mean A1C change after 6 months. Secondary measures included fasting blood glucose, lipids, blood pressure, weight, body mass index, and percentage of patients meeting goals. RESULTS:Patients in each group had an average of 8 and were taking 12 to 14 medications daily. Mean A1C (%) improvement in DIMM group was significantly greater at 6 months (-2.4 [SD = 2.1] vs -0.8 [SD = 1.7]; P < 0.001), than PCP group. Percentage meeting A1C goal levels (<7%, <8%, and <9%) was significantly greater at 3 and 6 months compared with baseline in the DIMM group (P < 0.001) versus (only <8%) at 3 and 6 months compared with baseline in PCP group. CONCLUSIONS: The DIMM clinic "tune up" model demonstrates a successful collaborative practice which helped complex diabetespatients achieve glycemic control in a 6-month period.
Authors: Leslie Carstensen Floren; Jennifer Mandal; Maria Dall'Era; Jaekyu Shin; David M Irby; Olle Ten Cate; Bridget C O'Brien Journal: Am J Pharm Educ Date: 2020-02 Impact factor: 2.047
Authors: Linda Awdishu; Renu F Singh; Ila Saunders; Felix K Yam; Jan D Hirsch; Sarah Lorentz; Rabia S Atayee; Joseph D Ma; Shirley M Tsunoda; Jennifer Namba; Christina L Mnatzaganian; Nathan A Painter; Jonathan H Watanabe; Kelly C Lee; Charles D Daniels; Candis M Morello Journal: Pharmacy (Basel) Date: 2019-10-11