Implementation and Evaluation of a Pharmacist-managed Diabetes Service

OBJECTIVE: To evaluate the impact of a pharmacist-managed diabetes service on changes in hemoglobin A1C (HbA), blood pressure, lipids, and smoking status in diabetic patients. DESIGN: A prospective analysis of the outcomes of a pharmacist-managed diabetes referral service compared to outcomes of standard medical care provided by physicians in a matched historical control. SETTING: Richmond Health Care Group, a managed care-affiliated physicians group in Virginia. PATIENTS: 16 type 2 diabetics in the historical control group; and 26 type 2 and 6 type 1 diabetics in the intervention group with a HbA" value greater than 8%, or a documented elevated systolic (over 130 mm Hg) or diastolic (over 85mm Hg) blood pressure, or elevated low density lipoprotein (LDL) cholesterol level that was 120% of goal or more. INTERVENTIONS: Patients in the intervention group received dosage adjustments, diabetes self-management training, and periodic assessment of treatment goals by pharmacists. MAIN OUTCOME MEASURES: HbA,c, systolic blood pressure (SBP), diastolic blood pressure (DBP), LDL, and smoking cessation. RESULTS: At the end of the study the mean :l:SD HbA" was 7.5 :I: 1.2% (95% CI, 7.05-7.98%) for the intervention group and 8.5 :I: 1.4% (95% CI, 7.8and-9.20%) for the historical control group, 11=0.02. There was no statistical difference in SBP and DBP between the two groups, although there was a trend toward a lower SBP in the intervention group (mean:l: SD SBP 133.5:1: 17.9 mm Hg; 95% CI, 127.2-139.9 mm Hg) compared with the historical control group (mean :I: SD SBP 140.1 :I: 14.9 mm Hg; 95% CI, 132.8-147.4 mm Hg), 11=0.22. There was no difference between baseline (mean :I: SD LDL 123.6 :I: 39.8 mg/dL; 95% CI, 108.3-138.9 mg/dL) and follow-up LDL (mean :I: SD LDL 121.2 :I:30.6 mg/dL; 95% CI, 102.2-140.2 mg/dL) by within-group analysis, 11=0.82. CONCLUSION: A pharmacist-managed diabetes service was effective in reducing HbA" values in diabetic patients. This study demonstrates the positive impact of clinical pharmacists in achieving a primary therapeutic goal in diabetic patients for overall diabetes control and possibly blood pressure.