title: Evaluation of the Impact of a Pharmacist-Led Telehealth Clinic on Diabetes-Related Goals of Therapy in a Veteran Population.
abstract: OBJECTIVE
  Telemedicine has been offered as a way to ensure that all patients, including those who live in rural areas, have access to the same health care. This study was performed to evaluate the benefit of a real-time, clinic-based video telehealth (Clinical Video Telehealth [CVT]) program and the impact of a pharmacist-led CVT clinic for chronic disease state management. The primary objective was to evaluate changes from baseline values, in veterans referred by primary care providers to this clinic.
  
  
  METHODS
  This was a single-center, prospective, pre-post pilot study that also included a post-patient satisfaction survey. The study was conducted at the Tennessee Valley Healthcare System, which is composed of two medical centers and 12 community-based outpatient clinics (CBOCs) located away from the two main facilities. Fifteen clinical pharmacy specialists (CPSs)-seven at the two main facilities and eight at the CBOCs-provide disease state management clinical pharmacy services. One of the seven CPSs at the main facilities works via telemedicine and provides services to the CBOCs where on-site clinical pharmacy services did not exist. The primary outcomes were changes from baseline in A1C, LDL level, systolic blood pressure, and diastolic blood pressure after 6 months of CVT services by the CPS. Secondary outcomes were the percentages of patients meeting American Diabetes Association treatment goals for hemoglobin A1c (A1C), low-density lipoprotein level, and blood pressure, both individually and in combination after attending a pharmacist-led CVT program; the level of patient satisfaction with pharmacists' care and with CVT as a method of receiving chronic disease management, specifically for diabetes; and medication additions or changes made by the pharmacist.
  
  
  RESULTS
  Twenty-six patients completed the 6-month evaluation. A significant decrease in A1C of 2% from baseline was observed (p=0.0002), and the percentage of patients meeting goal A1C significantly increased from 0% at baseline to 38% at 6 months (p=0.0007). Overall patient satisfaction scores were also high, with a median score 39.5 (interquartile range 36-40) of a maximum score of 40.
  
  
  CONCLUSIONS
  Six months of CVT clinic attendance significantly improved A1C values and the overall percentage of patients meeting their goal A1C values in this veteran population. In addition, patient satisfaction scores also indicated a high level of satisfaction with the pharmacist-led CVT service.
authors.affiliation: VA Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Lauralee G
authors.initials: LG
authors.lastname: Maxwell
authors.affiliation: VA Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Michael Shawn
authors.initials: MS
authors.lastname: McFarland
authors.affiliation: VA Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Jennifer Waymier
authors.initials: JW
authors.lastname: Baker
authors.affiliation: VA Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Regina F
authors.initials: RF
authors.lastname: Cassidy
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D017060:Patient Satisfaction; D010595:Pharmacists / Q000458:organization & administration*; D010865:Pilot Projects; D011446:Prospective Studies; D019114:Remote Consultation / Q000379:methods / Q000458:organization & administration; D017216:Telemedicine / Q000379:methods* / Q000458:organization & administration; D013714:Tennessee; D014728:Veterans / Q000706:statistics & numerical data
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: hemoglobin A1c; hyperlipidemia; hypertension; pharmacist; telemedicine; type 2 diabetes mellitus