title: Clinical Outcomes Associated With a Collaborative Pharmacist-Endocrinologist Diabetes Intense Medical Management "Tune Up" Clinic in Complex Patients.
abstract: BACKGROUND
  No previous studies exist examining the impact of a short-term pharmacist-endocrinologist collaborative practice model on glycemic control in complex patients.
  
  
  OBJECTIVE
  Evaluate outcomes associated with a PharmD-Endocrinologist Diabetes Intense Medical Management (DIMM) "tune up" clinic for complex patients.
  
  
  METHODS
  A retrospective cohort study of 99 patients referred to DIMM clinic versus a comparator group of 56 primary care provider (PCP) patients meeting the same criteria (adult type 2 diabetes patients, glycosylated hemoglobin [A1C] ≥ 8%, follow-up visit within 6 months) in a Veterans Affairs Medical Center. DIMM clinic used a short-term model that coupled personalized clinical care with real-time, patient-specific diabetes education during two to four 60-minute visits over 6 months. PCP patients received usual care. Primary outcome was mean A1C change after 6 months. Secondary measures included fasting blood glucose, lipids, blood pressure, weight, body mass index, and percentage of patients meeting goals.
  
  
  RESULTS
  Patients in each group had an average of 8 and were taking 12 to 14 medications daily. Mean A1C (%) improvement in DIMM group was significantly greater at 6 months (-2.4 [SD = 2.1] vs -0.8 [SD = 1.7]; P < 0.001), than PCP group. Percentage meeting A1C goal levels (<7%, <8%, and <9%) was significantly greater at 3 and 6 months compared with baseline in the DIMM group (P < 0.001) versus (only <8%) at 3 and 6 months compared with baseline in PCP group.
  
  
  CONCLUSIONS
  The DIMM clinic "tune up" model demonstrates a successful collaborative practice which helped complex diabetes patients achieve glycemic control in a 6-month period.
authors.affiliation: UC San Diego, La Jolla, CA, USA Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA candismorello@ucsd.edu.
authors.forename: Candis M
authors.initials: CM
authors.lastname: Morello
authors.affiliation: Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA Academic Detailing for VACO Pharmacy Benefits Management, San Diego, CA, USA.
authors.forename: Melissa L D
authors.initials: ML
authors.lastname: Christopher
authors.affiliation: UC San Diego, La Jolla, CA, USA Rite Aid in Ontario, CA, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Ortega
authors.affiliation: UC San Diego, La Jolla, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Khoan
authors.affiliation: UC San Diego, La Jolla, CA, USA.
authors.forename: Taylor
authors.initials: T
authors.lastname: Rotunno
authors.affiliation: UC San Diego, La Jolla, CA, USA Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Steven V
authors.initials: SV
authors.lastname: Edelman
authors.affiliation: UC San Diego, La Jolla, CA, USA Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Henry
authors.affiliation: UC San Diego, La Jolla, CA, USA Veterans Affairs of San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Jan D
authors.initials: JD
authors.lastname: Hirsch
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists; D010820:Physicians; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin
keywords: collaborative practice; medication regimen complexity; medication therapy management (MTM); pharmacist; type 2 diabetes; veterans