title: Federal Bureau of Prisons clinical pharmacy program improves patient A1C.
abstract: OBJECTIVE
  The Federal Bureau of Prisons (BOP) currently has over 13,000 patients with diabetes and has placed an emphasis on preventing and delaying the onset or progression of diabetes-related complications. In an ongoing effort to improve patient outcomes, BOP has implemented a nationwide, dynamic system of pharmacist-delivered patient care services via pharmacist clinicians working under the auspices of a physician-pharmacist collaborative practice agreement (CPA).
  
  
  METHODS
  The BOP Clinical Pharmacy Workgroup targets improved patient outcomes via oversight and support of institution pharmacist clinicians and physicians in establishing and maintaining physician-pharmacist CPAs. A primary emphasis is diabetes and the pharmacist-run clinic clinical outcomes data are presented.
  
  
  METHODS
  Seventy (nearly one-half) of eligible BOP pharmacists at 37 institutions offer pharmacist-delivered patient care services via an approved CPA. In total, BOP has 111 active physician-pharmacist CPAs.
  
  
  METHODS
  Pharmacist-run diabetes clinic outcomes from 5 institutions have been reported to date. A total of 126 patients were enrolled. Patient's hemoglobin A1C, blood pressure, and LDL cholesterol level are measured before (i.e., when accepted in the diabetes clinic) and after pharmacist-delivered care has been provided. The pharmacist-run diabetes clinics reported an average baseline A1C of 10.6% and produced an average outcome decrease in A1C of 2.3% from baseline.
  
  
  RESULTS
  Specific pharmacist clinic interventions found to have the greatest impact are: 1) timely medication adjustment when indicated to help patients meet outcome goals; and 2) timely follow-up after a change in therapy is made (often within 1-2 weeks) with continued medication adjustment when indicated until outcome goal is achieved.
  
  
  CONCLUSIONS
  BOP pharmacists have become respected and trusted clinicians within the team medicine model. As demonstrated by the pharmacist-run diabetes clinic outcomes, pharmacist clinicians are a valued link to the improvement of patient outcomes in BOP.
authors.forename: J Tyler
authors.initials: JT
authors.lastname: Bingham
authors.forename: Jeff J
authors.initials: JJ
authors.lastname: Mallette
mesh_terms: D003920:Diabetes Mellitus / Q000378:metabolism*; D035082:Federal Government; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007400:Interprofessional Relations; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010810:Physical and Rehabilitation Medicine; D011329:Prisoners / Q000706:statistics & numerical data; D011330:Prisons / Q000458:organization & administration*; D016730:Program Development / Q000706:statistics & numerical data; D014481:United States
chemical_list: D006442:Glycated Hemoglobin