title: Utilizing Clinical Pharmacy Specialists to Address Access to Care Barriers in the Veteran Population for the Management of Diabetes.
abstract: OBJECTIVE
  To show that clinical pharmacy specialists (CPSs) can be utilized in remote facilities to provide appropriate diabetes outcomes along with potential cost savings.
  
  
  METHODS
  A retrospective cohort chart review conducted at the Veterans Affairs North Texas Healthcare System (VANTHCS) evaluated outcomes in patients with type 2 diabetes mellitus referred to CPSs at Fort Worth Outpatient Clinic (FWOPC) or the endocrinologist-managed specialty clinic at the Dallas VA Medical Center (DVAMC). The primary outcome was percentage of patients reaching hemoglobin A1c (HbA1c) goal of <8%. Secondary outcomes were percentage of patients reaching HbA1c <7%, time to reach HbA1c goals of <8% and <7%, and cost savings.
  
  
  RESULTS
  There was no statistically significant difference in the number of patients reaching HbA1c goal <8% in the FWOPC (65.3%) compared to the DVAMC (55.8%). Secondary end points comparing FWOPC and DVAMC found no difference in patients reaching HbA1c <7% (20.8% vs 19.2%) and time to reach HbA1c goal of <8% (4.5 vs 6 months) and <7% (8.5 vs 7.5 months). Cost-saving analysis demonstrated a composite of US$350 292 could be saved by the VANTHCS facility if patients continued to be referred to CPS.
  
  
  CONCLUSIONS
  CPSs can be utilized in diabetes management to provide similar health outcomes as the endocrinologist-managed clinic and to potentially allow for facility cost savings.
authors: 1 Department of Pharmacy Practice, Ambulatory Care Division, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA.
authors: Krystal L
authors: KL
authors: Edwards
authors: 2 PGY2 Ambulatory Care Pharmacy Resident, Veterans Affairs North Texas Health Care System, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA.
authors: Ryan L
authors: RL
authors: Hadley
authors: 3 School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA.
authors: Nidhu
authors: N
authors: Baby
authors: 4 PGY2 Critical Care Pharmacy Resident, West Virginia University Medicine, WV, USA.
authors: Julianne C
authors: JC
authors: Yeary
authors: 5 Department of Pharmacy Practice, Ambulatory Care Division, Veterans Affairs North Texas Health Care System, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA.
authors: Lisa M
authors: LM
authors: Chastain
authors: 5 Department of Pharmacy Practice, Ambulatory Care Division, Veterans Affairs North Texas Health Care System, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX, USA.
authors: Crystal D
authors: CD
authors: Brown
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006297:Health Services Accessibility; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000706:statistics & numerical data*; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014728:Veterans
keywords: HbA1c; access to care; clinical pharmacy specialist; diabetes mellitus; veterans