Why the study?
Little is known about how to integrate pharmacy collaborative care services for hypertension and diabetes outside of clinical trials in safety net medical homes.
Does pharmacy collaborative care improve treatment goal achievement for hypertension and diabetes compared to primary care provider care alone in a safety net medical home?
Observational
No
Does pharmacy collaborative care improve treatment goal achievement for hypertension and diabetes compared to primary care provider care alone in a safety net medical home?
In a safety net medical home, a pharmacy collaborative care model did not significantly improve hypertension or diabetes control compared to standard primary care, highlighting the impact of baseline patient complexity and implementation barriers.
Should not yet change practice in safety-net settings; leaves open effects of complexity and implementation barriers on collaborative care.
Collaborative care models incorporating pharmacists have been shown to improve quality of care for patients with hypertension and/or diabetes. Little is known about how to integrate such services outside of clinical trials. The authors implemented a 22-month observational study to evaluate pharmacy collaborative care for hypertension and diabetes in a safety net medical home that incorporated population risk stratification, clinical decision support, and medication dose adjustment protocols. Patients in the pharmacy group saw their primary care provider (PCP) more often and had higher baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) and A1c levels compared to patients who only received care from their PCPs. There were no significant differences in the proportion of patients achieving treatment goals (SBP <140, DBP <90; A1c < 8) or the magnitude of change in BP or A1c among patients who underwent collaborative care versus those who did not. Age, race, and number of PCP encounters were associated with BP and A1c trends. The median time to achieve disease control was longer in the pharmacy group. Although 70% of all patients with poorly controlled hypertension achieved treatment goals within 7 months, less than 50% of patients with poorly controlled diabetes achieved A1c < 8 within 15 months, suggesting that diabetes was harder to manage overall. Contextual factors that facilitated or hindered practice redesign included organizational culture, health information technology and related workflows, and pharmacy caseload optimization. Future studies should further examine implementation strategies that work best in specific settings to optimize the benefits of team-based care with clinical pharmacists.
No takes yet. Share an insight, caveat, or question.
Price‐Haywood et al. (2016) conducted an observational in Hypertension and diabetes. Pharmacy collaborative care vs. Primary care provider (PCP) care only was evaluated on Proportion of patients achieving treatment goals (SBP <140, DBP <90; A1c < 8) or magnitude of change in BP or A1c.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: