Quality of care of a pharmacist-managed diabetes service compared to usual care in an indigent clinic.
BACKGROUND
This study evaluates the quality of care of a pharmacist-managed diabetes clinic focused on an indigent population and compares that quality of care to usual care in the same health care setting.


METHODS
Two groups of subjects were evaluated by retrospective review of medical records. The experimental group (n = 47) consisted of patients whose care was facilitated by a clinical pharmacist (medication initiation and modification, laboratory and physical assessment) in addition to routine physician care. A control group (n = 45) consisted of patients not referred to the pharmacy service whose care was provided solely by a physician. Changes in glycemic, blood pressure, and lipid control were assessed as were use of specific medications.


RESULTS
After an average of 1.8 years of follow-up, a larger reduction in hemoglobin A1C was observed in the experimental group (2.0%) compared to the control group (1.2%), but the difference was not statistically different. Both groups experienced significant improvements in blood pressure control with a higher absolute increase from baseline in the experimental group compared to the control group (34% vs. 22% respectively, P < 0.001). Low-density lipoprotein-cholesterol levels in the control group fell by 2 mg/dL, while a 29 mg/dL reduction was observed in the experimental group (P < 0.001). While aspirin, angiotensin-converting enzyme inhibitor, and angiotensin receptor blocker therapies were not different between the two groups, statin therapy was significantly improved in the experimental group (from 23% to 68%) compared to the control group (from 33% to 44%) (P = 0.038).


CONCLUSIONS
Many key diabetes quality of care outcomes in an indigent population were significantly improved in patients whose diabetes management was facilitated by a clinical pharmacist.
Irons
Brian K
BK
School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, TX 79430-8162, USA. brian.irons@ttuhsc.edu
Seifert
Charles F
CF
Horton
Niambi A
NA
D000554:Ambulatory Care Facilities; D001794:Blood Pressure; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists; D011203:Poverty; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013781:Texas; D016896:Treatment Outcome
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D008055:Lipids