The impact of clinical pharmacy services integrated into medical homes on diabetes-related clinical outcomes.
BACKGROUND
Pharmacist services have expanded in the US health-care system from traditional roles to include comprehensive clinical services, but many studies lack comparison groups to evaluate outcomes of these clinical services.


OBJECTIVE
To evaluate the clinical outcomes of uninsured or underinsured patients with type 2 diabetes who received care from pharmacists in local "safety net" clinic medical homes compared to outcomes of patients from clinics receiving usual care without the services of clinical pharmacists.


METHODS
Pharmacists provided comprehensive pharmacy services in safety net clinic medical homes for uninsured patients in a major urban city. Referred patients had poor diabetes control (hemoglobin A(1c) [A1C] >9%). Pharmacists conducted comprehensive evaluations of medications, made adjustments, monitored adherence, and provided education and follow-up. Intervention patients were compared to similar patients who were receiving usual care but were not seen by a pharmacist. Outcomes evaluated were the change in A1C levels and achievement of treatment goals. Data were derived from chart reviews retrospectively. Multivariate least-squares and logistic regression models were used to estimate the impact of the intervention.


RESULTS
Two hundred twenty-two intervention and 262 control patients were evaluated. Patients receiving care from pharmacists had adjusted A1C levels reduced by 1.38% relative to usual care, increasing the likelihood of achieving an A1C <7% by 3-fold (p < 0.001 for both estimates).


CONCLUSIONS
The integration of clinical pharmacy services into safety net medical homes was associated with improvement in clinical outcomes of patients with diabetes.
Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics & Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USA. kjohnson@usc.edu
Kathleen A
KA
Johnson
Steven
S
Chen
I-Ning
IN
Cheng
Mimi
M
Lou
Paul
P
Gregerson
Carla
C
Blieden
Mel
M
Baron
Jeffrey
J
McCombs
D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000379:methods*; D010607:Pharmacy Service, Hospital / Q000379:methods*
D006442:Glycated Hemoglobin; D008055:Lipids; C517652:hemoglobin A1c protein, human