title: Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?
abstract: BACKGROUND
  Although oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence.
  
  
  METHODS
  This retrospective cohort study analyzed 280,603 diabetes patients in 196 primary care clinics within the Veterans Affairs healthcare system. Pharmacists presence, number of pharmacist full-time equivalents (FTEs), and the degree to which pharmacy services are perceived as a bottleneck in each clinic were obtained from the 2007 VA Clinical Practice Organizational Survey-Primary Care Director Module. Patient-level adherence to OHAs using medication possession ratios (MPRs) were constructed using refill data from administrative pharmacy databases after adjusting for patient characteristics. Clinic-level OHA adherence was measured as the proportion of patients with MPR >= 80%. We analyzed associations between pharmacy measures and clinic-level adherence using linear regression.
  
  
  RESULTS
  We found no significant association between pharmacist presence and clinic-level OHA adherence. However, adherence was lower in clinics where pharmacy services were perceived as a bottleneck.
  
  
  CONCLUSIONS
  Pharmacist presence, regardless of the amount of FTE, was not associated with OHA medication adherence in primary care clinics. The exact role of pharmacists in clinics needs closer examination in order to determine how to most effectively use these resources to improve patient-centered outcomes including medication adherence.
authors.affiliation: Division of General Internal Medicine, University of Washington, 329 NinthAve, Campus Box 359780, Seattle, WA 98104, USA.
authors.forename: Beverly Mielke
authors.initials: BM
authors.lastname: Kocarnik
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Wong
authors.forename: Mark
authors.initials: M
authors.lastname: Perkins
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
mesh_terms: D000368:Aged; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D019538:Health Care Surveys; D006787:Hospitals, Veterans; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D010595:Pharmacists; D011320:Primary Health Care; D024382:Professional Role; D012189:Retrospective Studies; D014481:United States; D016903:Drug Monitoring
chemical_list: D007004:Hypoglycemic Agents