Pharmacist-led shared medical appointments for multiple cardiovascular risk reduction in patients with type 2 diabetes.
To assess whether VA MEDIC-E (Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction[EM DASH] Extended for 6 months), a pharmacist-led shared medical appointments program, could improve attainment of target goals for hypertension, hyperglycemia, hyperlipidemia, and tobacco use in patients with type 2 diabetes compared to standard primary care after 6 months of intervention.



A randomized, controlled trial of VA MEDIC-E (n = 50) versus standard primary care (n = 49) in veterans with type 2 diabetes, hemoglobin A1c (A1C) > 7%, blood pressure (BP) > 130/80 mmHg, and low density lipoprotein cholesterol (LDL-C) > 100mg/dl (2.59 mmol/l) in the previous 6 months was conducted. The VA MEDIC-E intervention consisted of 4 weekly group sessions followed by 5 monthly booster group sessions. Each 2-hour session included 1 hour of multidisciplinary diabetes specific healthy lifestyle education and 1 hour of pharmacotherapeutic interventions performed by a clinical pharmacist. Evaluation measures included lab values of A1C, LDL cholesterol, BP, and goal attainment of these values, and diabetes self-care behavior questionnaires at 6 months.



The randomization groups were similar at baseline in all cardiovascular risk factors except for LDL, which was significantly lower in the MEDIC-E arm. At 6 months, significant improvements from baseline were found in the intervention arm for exercise, foot care, and goal attainment of A1C, LDL-C, and BP but not in the control arm.



The results of this study demonstrate that the pharmacist-led group intervention program for 6 months was an efficacious and sustainable collaborative care approach to managing diabetes and reducing associated cardiovascular risk.
Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)|The Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley)
Lisa B
LB
Cohen
Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)|The Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley)|The Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Taveira, Dr Pirraglia, Dr Wu)
Tracey H
TH
Taveira
Sameed Ahmed M
SA
Khatana
Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)|The Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley)
Andrea G
AG
Dooley
Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)|The Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Taveira, Dr Pirraglia, Dr Wu)
Paul A
PA
Pirraglia
Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)|The Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Taveira, Dr Pirraglia, Dr Wu)
Wen-Chih
WC
Wu
D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000628:therapy*; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010349:Patient Compliance; D010595:Pharmacists; D040242:Risk Reduction Behavior; D012648:Self Care; D012657:Self-Help Groups; D014481:United States; D014728:Veterans