Clinical and economic impact of a diabetes clinical pharmacy service program in a university and primary care-based collaboration model.
OBJECTIVE
To provide program methodology and outcomes data identifying the impact of clinical pharmacy services (CPSs) in patients with type 2 diabetes.


METHODS
Longitudinal pre-post cohort study.


METHODS
Regional primary care group in Buffalo, NY, during 2006-2007.


METHODS
Patients with type 2 diabetes identified by their primary care providers were referred to the MedSense program; a pharmacist-led, patient-centered pharmacotherapy management program developed through university collaboration with a regional primary care physician group.


METHODS
Education, clinical assessments, provider recommendations, and longitudinal follow-up of treatment goals provided by MedSense pharmacists.


METHODS
Clinical outcomes were followed for 1 year from the index date for primary diabetes endpoints (glycosylated hemoglobin and fasting plasma glucose) and accompanying metabolic parameters (body mass index, blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides). Economic endpoints from the payer perspective were also followed for 1 year from the index date for medical and prescription-related costs.


RESULTS
Primary diabetes endpoints were significantly reduced versus baseline at the 6-month (-1.1%; P < 0.0001, -39 mg/dL; P = 0.003) and 12-month (-1.1%; P < 0.0001, -35 mg/dL; P = 0.005) assessments. Improvement rates were observed for all accompanying metabolic parameters at each assessment (range 40-64%). Geometric mean costs tended to decrease versus baseline at 6-month (-$84; P = 0.785) and 12-month (-$216; P = 0.414) assessments, despite nominal increases in diabetes and total medication costs.


CONCLUSIONS
In this CPS model, there were initial and sustained reductions in the primary diabetes endpoints and a high rate of improvement for accompanying metabolic parameters. Concurrent with clinical improvements, total direct medical costs were reduced despite an increase in antidiabetic medication and total medication costs.
Monte
Scott V
SV
School of Pharmacy and Pharmaceutical Sciences, University, Buffalo, NY, USA. smonte@cplassociates.com
Slazak
Erin M
EM
Albanese
Nicole Paolini
NP
Adelman
Martin
M
Rao
Gauri
G
Paladino
Joseph A
JA
D001786:Blood Glucose / Q000032:analysis; D003299:Cooperative Behavior; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000032:analysis; D006123:Group Practice / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D008137:Longitudinal Studies; D008329:Managed Care Programs / Q000191:economics* / Q000592:standards; D054539:Medication Therapy Management / Q000191:economics* / Q000592:standards; D018803:Models, Economic; D009518:New York; D017063:Outcome Assessment, Health Care; D010600:Pharmacology / Q000193:education; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000592:standards; D011320:Primary Health Care / Q000191:economics; D014495:Universities / Q000191:economics
D001786:Blood Glucose; D006442:Glycated Hemoglobin