title: Treat to goal: impact of clinical pharmacist referral service primarily in diabetes management.
abstract: OBJECTIVE
  To describe the impact of pharmacist services in a collaborative practice providing care to primarily Medicaid and indigent patients. The practice includes primary care physicians, nurses, a care navigator, and pharmacists. Pharmacy services are provided by pharmacists, including PGY-1 pharmacy residents and pharmacy students.
  
  
  METHODS
  A retrospective chart review was conducted to perform a pre-post analysis on all patients referred to pharmacists within an adult medicine clinic. Patients were included if they were more than 18 years old; were referred for type 1 or 2 diabetes mellitus, hypertension, hyperlipidemia, or medication reconciliation; and were seen from August 2010 to March 2011. All charts were reviewed to assess pharmacist impact on adherence to standards of care including hemoglobin A1c; lipids; blood pressure; vaccination status; usage of aspirin, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins; and other criteria. Subgroup analysis was performed on diabetic patients who were not at goal at the time of referral to the pharmacy clinic.
  
  
  RESULTS
  Ninety-three charts were reviewed. In the overall group, rates of influenza and pneumococcal vaccination improved significantly, as did annual foot and eye exams in diabetics. Pharmacists significantly decreased A1c from 9.12% at baseline to 8.13% (P < .001), systolic blood pressure (SBP) from 142.6 to 133.5 mm Hg (P < .001), and low-density lipoprotein (LDL) from 143.6 to 103.2 mg/dL (P < .001) in diabetic patients who were not at goal at baseline.
  
  
  CONCLUSIONS
  Pharmacists were effective in improving surrogate outcomes for patients with diabetes and in assisting physicians to address all standards of care.
authors.affiliation: Clinical Pharmacist, Department of Pharmacy, CaroMont Regional Medical Center, Gastonia, North Carolina;
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Henry
authors.affiliation: Clinical Pharmacist, Residency Program Director, W.W. Knight Family Practice Center, Toledo, Ohio;
authors.forename: Steven
authors.initials: S
authors.lastname: Smith
authors.affiliation: The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio. Corresponding author: Thomas M. Henry, PharmD, BCPS, CaroMont Regional Medical Center, 2525 Center Drive, Gastonia, NC 28052; phone: 704-834-2000; e-mail: henrytm@caromonthealth.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Hicho
keywords: diabetes mellitus; hyperlipidemias; pharmaceutical services; pharmacists; standard of care; vaccination