Pharmacist-Driven Pre-Visit Planning to Optimize Prescribing in Type 2 Diabetes

OBJECTIVE Adolescents and young adults with type 2 diabetes face socioeconomic barriers to initiation of guideline-directed therapy. Ambulatory care pharmacists are well positioned to address medication access and prescribing gaps through interdisciplinary care models. This article describes the implementation and outcomes of a pharmacist-led pre-visit planning quality improvement initiative to optimize prescribing of guideline-directed therapies in adolescents and young adults with type 2 diabetes. RESEARCH DESIGN AND METHODS A pharmacist-driven quality improvement initiative was implemented at The University of Chicago Medicine Kovler Diabetes Center in October 2022. Patients aged 10–44 years with type 2 diabetes and HbA1c >7% were identified prior to scheduled endocrinology visits with use of electronic medical record reports. Pharmacists conducted pre-visit chart reviews, assessed eligibility for sodium–glucose cotransporter 2 inhibitors and glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonists, evaluated insurance coverage, and communicated recommendations to providers using standardized STEP (Supporting Teamwork that Empowers Patients) notes. Plan-Do-Study-Act (PDSA) cycles were used to refine workflow and prescribing outcomes. RESULTS A total of 93 unique patients received pharmacist STEP notes between October 2022 and May 2025. Providers prescribed recommended therapy for 38% of patients; 34% of recommendations were not implemented due to missed visits. Among patients with follow-up data, mean HbA1c decreased from 8.7% at baseline to 7.8% at 3–6 months. Prescribing rates improved across successive PDSA cycles. CONCLUSIONS Pharmacist-led pre-visit planning may improve access to guideline-directed therapy and may support glycemic improvement in adolescents and young adults with type 2 diabetes. This interdisciplinary care model addresses medication access barriers and therapeutic inertia in high-risk populations.