title: Analysis of Glycemic Control of a Pharmacist-Led Medication Management Program in Patients with Type 2 Diabetes.
abstract: BACKGROUND
  An integrated health care system with its own regional health plan located in Texas implemented a pharmacist-led diabetes medication management program (MMP) to treat type 2 diabetic patients (baseline A1c > 7.5%). The MMP formed collaborative practice agreements with the system's physicians to allow ambulatory care pharmacists to modify and adjust diabetic drug regimens when appropriate. Enrolled MMP patients received personalized visits with ambulatory care pharmacists and a copay waiver on diabetes medications.
  
  
  OBJECTIVE
  To study the outcomes of an outpatient, pharmacist-led MMP, along with a copay waiver on diabetes drugs, in treating adults with type 2 diabetes mellitus over a 2-year period compared with standard care practice.
  
  
  METHODS
  This retrospective study employed a quasi-experimental design and used medical claims, pharmacy claims, eligibility data, and electronic medical records. Patients aged 18 to 62 years, who were diagnosed with type 2 diabetes mellitus, and had at least 1 diabetes-related pharmacy claim in the year before the MMP, as well as continuous enrollment in the health plan, were included. Patients enrolled in the pharmacist-led MMP for at least 2 years (n =75) were matched to standard care patients (n =75) on age, gender, baseline A1c, insulin use, and physical comorbidity. The primary outcome was the 2-year change in A1c. Secondary outcomes included inpatient costs, outpatient costs, and pharmacy costs from the baseline period (year before enrollment) compared with the follow-up period (second year of enrollment).
  
  
  RESULTS
  After matching MMP patients (n = 75) to control patients (n = 75), the baseline A1c (9.30 and 9.26), the mean age (53.0 and 53.3, respectively), the Selim Physical Score (3.32 and 3.26, respectively), and the use of insulin (56.0% and 56.0%, respectively) were similar in both groups. MMP patients had a greater mean reduction in A1c compared with standard care patients (-1.24 vs. -0.59, P = 0.009) from baseline to after 2 years. After 2 years, the A1c for MMP patients was significantly lower compared with control patients (8.06 vs.8.67, respectively, P = 0.014). There was also a difference in A1c after 1 year for MMP patients versus control patients (8.18 and 8.69, respectively, P = 0.012).
  
  
  CONCLUSIONS
  A pharmacist-led diabetes MMP, combined with a diabetes drug copay waiver, was effective in significantly reducing A1c over a 2-year period for type 2 diabetic patients in this regional health plan.
authors.affiliation: 1 Associate Director, Health Economics and Outcomes Research, Novartis, East Hanover, New Jersey.
authors.forename: John J
authors.initials: JJ
authors.lastname: Ko
authors.affiliation: 2 Regional Clinical Account Director, Medical Affairs, AstraZeneca, New York City, New York.
authors.forename: Jackie
authors.initials: J
authors.lastname: Lu
authors.affiliation: 3 Professor of Pharmacy, Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin.
authors.forename: Karen
authors.initials: K
authors.lastname: Rascati
authors.affiliation: 4 Research Statistician, Center for Applied Health Research, jointly sponsored by Central Texas Veterans Health Care System and Baylor Scott & White Health, Temple, Texas.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Stock
authors.affiliation: 5 Clinical Pharmacist, CDM Pharmacy, Scott & White Health Plan, Temple, Texas.
authors.forename: Joyce
authors.initials: J
authors.lastname: Juan
authors.affiliation: 6 PhD Candidate, Pharmaceuticals Outcomes Research & Policy Program, University of Washington, Seattle.
authors.forename: Kangho
authors.initials: K
authors.lastname: Suh
authors.affiliation: 7 Researcher, Health Economics, Proteus Digital Health, Redwood City, California.
authors.forename: Yoona
authors.initials: Y
authors.lastname: Kim
authors.affiliation: 8 Manager, Clinical Pharmacy Services, Scott & White Health Plan, Temple, Texas.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Tabor
authors.affiliation: 9 Director, Health Plan Pharmacy Services, Scott & White Health Plan, Temple, Texas.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Godley
mesh_terms: D001786:Blood Glucose / Q000187:drug effects*; D019033:Delivery of Health Care, Integrated / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D017048:Health Care Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D000070516:Intersectoral Collaboration; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010593:Pharmaceutical Services; D010595:Pharmacists; D012189:Retrospective Studies; D013781:Texas
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin