Implementation of a pharmacotherapy clinic into the patient centered medical home model by a second year pharmacy resident.
OBJECTIVE
Evaluate the impact a post graduate year 2 (PGY-2) pharmacy resident run clinic incorporated into the patient centered medical home (PCMH) model may have on achieving reduction in glycosylated hemoglobin (A1c), low density lipoprotein (LDL), and systolic and diastolic blood pressures (SBP and DBP) over six months in type 2 diabetics within the Veterans Health Administration (VHA).


METHODS
This was a prospective, quasi-experimental study enrolling type 2 diabetics referred to the pharmacist-run clinic not meeting American Diabetes Association (ADA) treatment goals for A1c less than 7%, and/or LDL less than 100 mg/dL, and/or blood pressure (BP) less than 130/80 mmHg. Once signed informed consent was obtained, veterans were followed according to usual standards of care for six months with visits and lab follow-up at baseline, three, and six months (±45 days). The primary endpoint was the change in HbA1c, LDL, and BP from baseline to six months. Secondary endpoints included the change from baseline to three months in A1c, LDL, and BP and the percentage of patients who achieved ADA treatment goals for A1c, LDL, and BP at six months.


RESULTS
Among the 24 patients included in the data analysis (100% male, 92% Caucasian), A1c decreased significantly from 7.56% to 7.19% (p = 0.0122) as well as LDL from 92.9 to 68.5 mg/dL (p = 0.0023), SBP from 131 to 124 mmHg (p = 0.0302), and DBP from 71.5 to 64.8 mmHg (p = 0.0012). The proportion of patients at recommended goal A1c <7% rose from 17% to 38%, as did the percentage of patients meeting ADA goals for LDL (75% to 96%), SBP (46% to 71%), and DBP (79% to 92%).


CONCLUSIONS
Patients followed in a resident run pharmacotherapy clinic in the PCMH model with interventions over six months showed significant improvements in clinical endpoints including A1c, LDL, SBP, and DBP.
Clinical Pharmacist Specialist, Alvin C. York Veterans Administration, Murfreesboro, TN Kristen.Lamb@va.gov.
Kristen D
KD
Lamb
Clinical Pharmacist Specialist, Alvin C. York Veterans Administration, Murfreesboro, TN.
Jennifer W
JW
Baker
Clinical Pharmacist Specialist, Alvin C. York Veterans Administration, Murfreesboro, TN.
M Shawn
MS
McFarland
D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004514:Education, Pharmacy, Graduate / Q000458:organization & administration*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007397:Internship, Nonmedical / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin