* Indicates p < 0.05

indicates p < 0.05

Evaluating Clinical Pharmacist Impact on Diabetes Control*Mary Ella Hill, Pharm. D. Candidate; Orijane Dalton, Pharm. D. Candidate; Seth Hill, BS; Emily McCoy Armstrong, Pharm. D, BPACP

BackgroundPharmacists collaborating with patients with chronic medical conditions, such as Diabetes Mellitus, could improve reduce blood glucose levels and improve patient outcomes2003- The Asheville Project: Pharmacist impact on Diabetes patients improved HbA1c and lipid levels by >50%, and decreased number in sick days, and direct patient costs 1,2,3

2008- Pharmacist-managed Diabetes Mellitus Under Collaborative Drug Therapy Agreement: Significantly reduced HbA1c, mean blood glucose, and patient costs 4

2008- Systematic review on Effects of Pharmacist Outpatient Interventions on Adults with Diabetes: Noted decreases in HbA1c, Blood pressure, LDL, and triglycerides in patients with Diabetes 5

MethodsApproved by the Institutional Review Board for University of South Alabama and Auburn UniversityRetrospective chart reviewPatient population from internal medicine outpatient clinicData obtained by chart review and electronic medical recordsData collected was de-identifiedInclusion Criteria:

ICD-9 code for Type 2 DiabetesHave had a valid patient-provider relationship with the clinical pharmacist at Knollwood Physicians groupSeen between January 1, 2010 and December 31, 2011

Exclusion Criteria:PregnantRenal or hepatic diseaseAge less than 19

ConclusionsPreliminary results suggest clinical pharmacists have most significant impact on HbA1c in first 3 to 6 months of treatmentImprovement in lipid values was statistically significant for triglycerides at 3 months and HDL at 9 months of treatmentThis study illustrates that clinical pharmacists can have a positive impact on diabetes managementThe limitation of the small sample size at 9 and 12 months may have contributed to non-significant values

Interim Results & Analysis262 charts identified26 charts with results at this timeHbA1c lower than baseline at each follow up interval, with change reaching statistical significance at 3 months (p=0.036)Statistically significant decrease in triglycerides (p=0.0229) and HDL improvement (p=0.038) also seen at 3 and 9 month mark, respectivelyNo significant improvements seen in blood pressure, total cholesterol, or LDL levels8 (31%) patients converted to insulin therapyAverage number of diabetic medications increased from 1.5 to 2 medications per person

Strengths Limitations•Inexpensive•Data readily accessible•Uses existing data

•Retrospective•Relies on accuracy of written record•One pharmacist at clinic•Small sample size

References1. Cranor CW, Christensen DB. The Asheville Project: Factors Associated With Outcomes of Community Pharmacy Diabetes Care Program. Journal of the American Pharmaceutical Association [Internet]. 2003 March [cited 2012 November 6]; 43 (2):160-172. Available from: http://www.ncpharmacists.org/associations/4188/files/NCCPCthree.pdf2. Cranor CW, Christensen DB. The Asheville Project: Short-Term Outcomes of Community Pharmacy Diabetes Care Program. Journal of American Pharmaceutical Association [Internet]. 2003 March [cited 2012 November 6]; 43 (2):149-159. Available from: http://www.ncpharmacists.org/associations/4188/files/NCCPCtwo.pdf3. Cranor CW, Bunting BA, Christensen DB. 3. The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care Program. Journal of American Pharmaceutical Association [Internet]. 2003 March [cited 2012 November 6]; 43 (2): 173-184. Available from: http://www.ncpharmacists.org/associations/4188/files/NCCPCfour.pdf4. Anaya JP, Rivera JO, et al. Evaluation of pharmacist-managed diabetes mellitus under a collaborative drug therapy agreement. American Journal Health-Systems Pharmacy [Internet]. 2008 October [cited 2012 November 6]; 65: 1841-1845. Available from: http://www.ncbi.nlm.nih.gov.libproxy2.usouthal.edu/pubmed/187964265. Wubben DP, Vivian EM. Effects of Pharmacist Outpatient Interventions on Adults with Diabetes Mellitus: A Systematic Review. Pharmacotherapy [Internet]. 2008 November [cited 2012 November 6]; 28(4): 421-436. Available from: http://pharmacotherapyjournal.org.libproxy2.usouthal.edu/doi/pdf/10.1592/phco.28.4.421

Disclosure•Authors of this presentation have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation.

ObjectivesPrimary ObjectivesAssess pharmacist impact through collaborative patient care on HbA1c valuesSecondary ObjectivesAverage blood pressure readingsChange in average lipidsNumber of patients converted to insulinNumber of diabetes medications

Baseline CharacteristicsVariable Mean SD Min Max

Age 59.75 10.23 36 72Female 0.53 0.51 0 1Non-White 0.33 0.4815 0 1

# Comorbid Conditions 5.08 1.84 2 9# Medications 7.5 3.93 2 18HbA1C 9.02 2.09 6.2 13.2Scr 1.16 0.87 0.47 4.8TC 202 50 112 285TG 198 121 50 507HDL 45 15 24 100LDL 115 43 45 200AST 31 25 13 116ALT 33 28 6 116

Urine microalb/Cr ratio 78.47 172.7 1.9 653.3SBP 131 13 106 152DBP 80 9.4 60 98

Interim Results

Variable Baseline 3 months 6 months 9 months 12 months

SBP 131.13 128.94 129.14 125.25 134DBP 80.36 77.38 75.07 76.25 82.75SCr 1.16 1.028 1.066* 1.064 0.946Urine microalb/Scr 73.63 126.26 N/A N/A N/A

AST 30.8 28.33 27.7 30.4 25.13ALT 33.3 30.5 29.9 33 28.5

* Indicates p < 0.05

**

Mean Lipid Values