Patient self-management program for diabetes: first-year clinical, humanistic, and economic outcomes.
OBJECTIVE
To assess the outcomes for the first year following the initiation of a multisite community pharmacy care services (PCS) program for patients with diabetes.


METHODS
Quasi-experimental, pre-post cohort study.


METHODS
80 community pharmacy providers with diabetes certificate program training who were reimbursed for PCS by employers in Greensboro, N.C., Wilson, N.C., Dublin, Ga., Manitowoc County, Wis., and Columbus, Ohio.


METHODS
256 patients with diabetes covered by self-insured employers' health plans.


METHODS
Community pharmacist patient care services using scheduled consultations, clinical goal setting, monitoring, and collaborative drug therapy management with physicians and referrals to diabetes educators.


METHODS
Changes in glycosylated hemoglobin (AIC), low-density lipoprotein cholesterol (LDL-C), blood pressure, influenza vaccinations, foot examinations, eye examinations, patient goals for nutrition, exercise, and weight, patient satisfaction, and changes medical and medication utilization and costs.


RESULTS
Over the initial year of the program, participants' mean A1C decreased from 7.9% at initial visit to 7.1%, mean LDL-C decreased from 113.4 mg/dL to 104.5 mg/dL, and mean systolic blood pressured decreased from 136.2 mm Hg to 131.4 mm Hg. During this time, influenza vaccination rate increased from 52% to 77%, the eye examination rate increased from 46% to 82%, and the foot examination rate increased from 38% to 80%. Patient satisfaction with overall diabetes care improved from 57% of responses in the highest range at baseline to 87% at this level after 6 months, and 95.7% of patients reported being very satisfied or satisfied with the diabetes care provided by their pharmacists. Total mean health care costs per patient were $918 lower than projections for the initial year of enrollment.


CONCLUSIONS
Patients who participated in the program had significant improvement in clinical indicators of diabetes management, higher rates of self-management goal setting and achievement, and increased satisfaction with diabetes care, and employers experienced a decline in mean projected total direct medical costs.
Garrett
Daniel G
DG
American Pharmacists Association Foundation, Washington, D.C. 20037-2985, USA. dgarrett@aphanet.org
Bluml
Benjamin M
BM
D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003157:Community Pharmacy Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data; D015444:Exercise / Q000502:physiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods; D017060:Patient Satisfaction / Q000191:economics / Q000706:statistics & numerical data; D010865:Pilot Projects; D015397:Program Evaluation / Q000706:statistics & numerical data*; D012648:Self Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin