The Asheville Project: factors associated with outcomes of a community pharmacy diabetes care program.
OBJECTIVE
To assess the importance of environment, patient characteristics, and health behavior in explaining differences in clinical, economic, and humanistic outcomes of pharmaceutical care services (PCS) for patients with diabetes.


METHODS
Quasi-experimental, pre-post cohort-with-comparison group study using multivariate logistic regression.


METHODS
Twelve community pharmacies in Asheville, N.C.


METHODS
Eighty-five patients with diabetes who were employees, dependents, or retirees from two self-insured employers; community pharmacists who completed a diabetes certificate program and received reimbursement for PCS.


METHODS
Scheduled consultations with pharmacists involving education and training, assessment, monitoring, follow-up, and referral.


METHODS
Change in glycosylated hemoglobin (A1c) value, diabetes diagnosis and all-diagnosis utilization and cost of medical care, quality of life, and satisfaction with pharmacy services.


RESULTS
The strongest predictors of improvement in A1c following PCS were the patient characteristics baseline glycemic control and type 1 diabetes. All patients with type 1 diabetes had reduced their A1c concentrations at follow-up. Patients in one employer group (an environmental characteristic) were significantly more likely to have a 10% reduction in diabetes diagnosis costs, compared with employees in the other group. They were also more likely to report improved satisfaction with pharmacy services. No other statistically significant relationships were found.


CONCLUSIONS
The greatest improvement in A1c occurred among patients with type 1 diabetes and/or higher baseline A1c concentrations. When controlling for other factors, PCS did not emerge as a significant factor in lowering A1c, but it was imprecisely measured, and our proxy measure did not capture the full complement of PCS provided to patients. Success in terms of cost savings and patient satisfaction differed by employer group.
Cranor
Carole W
CW
University of North Carolina-Chapel Hill, USA. carole.cranor@rtp.ppdi.com
Christensen
Dale B
DB
D000293:Adolescent; D000328:Adult; D000368:Aged; D003157:Community Pharmacy Services / Q000191:economics; D003376:Counseling; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010595:Pharmacists; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D006442:Glycated Hemoglobin