2030-P: Impact of a Three-Visit Pharmacist Consult Model in a Specialty Diabetes Practice

Introduction and Objective: Pharmacists involved in diabetes management through a collaborative practice agreement often follow patients longitudinally or until a target is met. While this model improves outcomes, over time access for new patients diminishes. To address this issue, we developed and tested a 3-visit referral model to pharmacists between longitudinal provider visits. Methods: Endocrinology providers referred patients with diabetes who started a new medication or required titration or education. We measured change in A1c, factors that might influence change in A1c, and relationship between number of visits and outcomes. Hospitalization or emergency department visit related to diabetes and clinic wait times for diabetes appointments were reviewed. We defined A1c response categories: high (≥ 1%), medium (0.4-0.9) and low (<0.4%). Results: 374 patients were referred to a pharmacist over 20 months; 342 with A1c ≥6.5% were included for analysis. At baseline, age: 60±15 years, race: Black 26%, White 52%, Asian 4.1%; 53% were Female. Baseline A1c was 9.2%±2.4. Median number of pharmacist visits per patient was 3.0 [IQR 3.0]. Change in A1c was -1.2% ± 2.3 (p<0.01). After adjusting for baseline, A1c change was independent of age and race. Each additional visit beyond 1 was associated with an increased chance of a higher A1c response category (OR 1.12; 95% CI 1.03-1.22; p<0.01), no continuous relationship between number of visits and A1c. 16 safety events resulted in ED visit or hospitalization, none were determined related to pharmacist visit. All patients accessed appointments within 2 months. Conclusion: This unique limited-visit model for pharmacist consultation in a diabetes specialty practice for medication initiation, titration, and education is safe and effective. Disclosure G. Stern: None. E.L. Barbay: None. A. Segal: Other - Editor-in-Chief, Diabetes, Obesity, and Cardiometabolic CARE; Current; American Diabetes Association. Board Member; Current; Diabetes Education for All. M.E. McDonnell: Research Support; Ended; Dexcom, Inc. Research Support; Current; Abbott Diabetes. Advisory Panel; Ended; Vertex Pharmaceuticals Incorporated.