title: Team-based care approach to cholesterol management in diabetes mellitus: two-year cluster randomized controlled trial.
abstract: BACKGROUND
  Creative, cost-effective interventions to improve the quality of care of chronic illnesses are needed. This study was designed to evaluate the impact of remote physician-pharmacist team-based care on cholesterol levels in patients with diabetes mellitus (DM).
  
  
  METHODS
  This 2-year prospective, cluster randomized controlled trial was conducted within the Providence Primary Care Research Network in Oregon. Participants at least 18 years of age were identified by a diagnosis of DM. The intervention included remote physician-pharmacist team-based care focused on cholesterol management in DM. All clinicians in the study had access to the health information technology tool CareManager, which provided automated DM-related point-of-care prompts, a Web-based registry, and performance feedback with benchmarking. Study outcomes included the difference in low-density lipoprotein cholesterol (LDL-C) goal attainment, mean LDL-C, prescribed lipid-lowering therapy, and patient satisfaction between the intervention and control arms.
  
  
  RESULTS
  A total of 6963 patients with DM cared for by 68 physicians in 9 clinics were evaluated. Patients in the intervention arm were more likely to achieve their target LDL-C levels compared with controls (78% vs 50%; P = .003). The mean LDL-C level was 12 mg/dL lower in the intervention arm compared with the control arm (P < .001). The rate of LDL-C testing was significantly higher in the intervention arm compared with the control arm. Patients in the intervention arm were also 15% more likely to receive a prescription for a lipid-lowering medication (P = .008). There was no significant difference in patient satisfaction between study arms (P = .15).
  
  
  CONCLUSIONS
  Remotely located physician-pharmacist team-based care resulted in significantly improved LDL-C levels and goal attainment among patients with DM.
authors.affiliation: Providence Medical Group, Portland, OR 97208, USA. ginger.pape@providence.org
authors.forename: Ginger A
authors.initials: GA
authors.lastname: Pape
authors.forename: Jacquelyn S
authors.initials: JS
authors.lastname: Hunt
authors.forename: Kristina L
authors.initials: KL
authors.lastname: Butler
authors.forename: Joseph
authors.initials: J
authors.lastname: Siemienczuk
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: LeBlanc
authors.forename: William
authors.initials: W
authors.lastname: Gillanders
authors.forename: Yelena
authors.initials: Y
authors.lastname: Rozenfeld
authors.forename: Kerry
authors.initials: K
authors.lastname: Bonin
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002784:Cholesterol / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D010349:Patient Compliance; D017060:Patient Satisfaction; D010595:Pharmacists; D010820:Physicians; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D002784:Cholesterol; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human