Nov 30, 2010 - OBJEC TIVE: To evaluate the clinical outcomes of uninsured or underinsured patients with type 2 diabeteswho received care from pharmacists ...
RESEARCH REPORTS Diabetes
The Impact of Clinical Pharmacy Services Integrated into Medical Homes on Diabetes-Related Clinical Outcomes Kathleen A Johnson, Steven Chen, I-Ning Cheng, Mimi Lou, Paul Gregerson, Carla Blieden, Mel Baron, and Jeffrey McCombs
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Pproximately 44 million people in the US are uninsured , low-income underinsured, Medicaid beneficiaries, or patients with special health -care needs who do not rece ive regular medical care.P Uninsured indiv iduals are less likely to have a regular source of care and are more likely to report dela ys in seeking care or not having received needed care. As a result, a network of "safety net" providers has evolved, operated by informal priva te organi zations that serve as a default hea1th-care system for people with little or no health insurance.' Though the range of coverage and services available vary from state to state, safety net providers have played an important role as the medical home for the underserved. Patients with diabetes may be particularly vulnerable to poor outcomes as a result of not having a regular source of care. The burden of diabetes falls disproportion ately on minority populations.Y including African Americans, HispaniclLatino Americans, Native Americans ,
BACKGROUND: Pharmacist services have expanded in the US health-eare system fromtraditional roles to include comprehensive clinicalservices, but many studies lack comparison groupsto evaluateoutcomes of theseclinical services. OBJEC TIVE: To evaluate the clinical outcomes of uninsured or underinsured patients with type 2 diabeteswho received care from pharmacists in local "safety net" clinic medical homescompared to outcomesof patients from clinics receiving usual care without the services of clinical pharmacists. METHODS: Pharmacists provided comprehensive pharmacy services in safety net clinic medical homesfor uninsured patients in a majorurban city. Referredpatients had poor diabetes control (hemoglobin Ale[A1C] >9%). Pharmacists conducted comprehensive evaluations of medications, made adjustments, monitored adherence, and providededucation and follow-up. Intervention patients were compared to similar patientswho were receiving usual care but were not seen by a pharmacist. Outcomes evaluated werethe change in A1C levels and achievement of treatment goals. Data were derived from chart reviews retrospectively. Multivariate least-squares and logistic regression models were used to estimate the impact of the intervention.
Two hundred twenty-two intervention and 262 control patients were evaluated. Patients receiving care from pharmacists had adjusted A1C levels reduced by 1.38% relative to usual care, increasing the likelihoodof achieving an A1C 18 years; N=325
AIC >9% within enrollment pertod', Age>18 years; N=310
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Visit more than twice N=224
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Had a visit +30 to +750 days after index date N=222d
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Visit more than twice N=265
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Identical data were collected for both usual care and pharmacist intervention groups. In the pharmacist intervention group, data were abstracted from an electronic medical record. Because electronic health records were not available for the usual care group, data were collected retrospectively by medical chart review using a data collection instrument designed to parallel the electronic medical record used for intervention patients. Data were collected from 6 months prior to the index date through the end of June 2007. A list of patients with type 2 diabetes in each clinic was generated and all charts for these individuals were pulled alphabetically in order to identify patients meeting the inclusion or exclusion critieria. DEFINmON ANDMEASUREMENT OFOUTCOME VARIABLES
The primary outcome variables for this study were defined as the change in AIC levels from baseline to the last measured posttreatment AIC value up to 2 years, and whether or not the patient achieved the treatment goal of a final AIC 9%). cEnrollment periodJanuary" 2004-December 31, 2006.dFinal sample Includes 103fewerIndividuals because they had
