Clinical impact of a pharmacist-managed diabetes mellitus drug therapy management service.
OBJECTIVE
To evaluate the impact of clinical pharmacist interventions, including drug therapy management, on outcomes relevant to diabetes mellitus.


METHODS
Retrospective chart review.


METHODS
Ambulatory, multispecialty physician group practice within a managed care environment in suburban Chicago, Illinois.


METHODS
Three hundred sixteen patients aged 18 years or older, with a diagnosis of diabetes mellitus (89% with type 2), who were referred to a clinical pharmacy service.


METHODS
Drug therapy management and education service provided by a clinical pharmacist.


RESULTS
Data were collected for glycosylated hemoglobin A(1c) (A1C), blood pressure, and low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride concentrations. Data also were collected regarding patient adherence with American Diabetes Association guidelines for preventive care, including annual eye and foot examinations, influenza shots, and daily aspirin use at both baseline and follow-up. Mean +/- SD A1C reduction was 1.4% +/- 1.94% (p<0.001); the percentage of patients whose A1C was at goal level at baseline (< 7%) increased from 14.8% to 43.2% (p<0.001). Mean +/- SD LDL level reduction was 14 +/- 41.1 mg/dl (p=0.002), mean +/- SD triglyceride level reduction 42 +/- 97.6 mg/dl (p<0.001). The percentage of patients who reached goal for LDL level (< 100 mg /dl), HDL level (> 40 mg/dl), and blood pressure (< 130/80 mm Hg) did not increase significantly from baseline, whereas those who reached the triglyceride level goal (< 150 mg/dl) increased from 36% to 55% (p<0.005). Frequency of annual dilated retinal examinations and monofilament foot examinations increased by 29% (p<0.05) and 12.5% (p<0.05), respectively. Daily aspirin use increased from 35% to 59% (p<0.05).


CONCLUSIONS
Significant clinical improvement occurred in patients referred to the pharmacist in a diabetes drug therapy management program.
McCord
Amie D
AD
From the Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois 60515, USA. amccor@midwestern.edu
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL / Q000097:blood; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration*; D010353:Patient Education as Topic; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists; D012189:Retrospective Studies; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D014280:Triglycerides