title: Assessing the Effect of Pharmacist Care on Diabetes-Related Outcomes in a Rural Outpatient Clinic: A Retrospective Case-Control Study.
abstract: BACKGROUND
  The care of diabetic patients in rural areas is complicated by factors such as poor health literacy, cultural barriers, and primary care provider (PCP) shortages. Integrating pharmacist care in diabetes management in these settings may increase access to care and improve patient outcomes.
  
  
  OBJECTIVE
  To evaluate differences in diabetes-related outcomes in patients with type 2 diabetes (T2DM) managed by a pharmacist diabetes clinic compared with patients only managed by PCPs in a rural family medicine clinic.
  
  
  METHODS
  This was a retrospective case-control study. The primary outcome was achievement of hemoglobin A1C(A1C) reduction ≥0.5%. Secondary outcomes included average A1C reduction, achievement of A1C goal, angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) use, statin use, blood pressure control, and frequency of nephropathy screenings. Patients ≥18 years old with an A1C ≥7% were eligible. Cases included patients established with the pharmacist diabetes clinic. Cases were matched to controls in a 1:1 ratio based on PCP, age (±5 years), gender, and race.
  
  
  RESULTS
  A total of 21 pharmacist-managed patients met inclusion criteria. Cases were significantly more likely to experience an A1C reduction ≥0.5% (odds ratio = 7.51; 95% CI = 1.54-36.61; P < 0.01). Statistically significant improvements were also noted for ACE inhibitor/ARB use, statin use, and nephropathy screenings among cases.
  
  
  CONCLUSIONS
  Patients managed by a pharmacist diabetes clinic were more likely to experience improved diabetes-related outcomes, including A1C reduction ≥0.5%. Pharmacist care, when added to standard care, can improve outcomes for patients with T2DM in rural areas.
authors.affiliation: 1 Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Moreau
authors.affiliation: 2 University of Florida College of Pharmacy, Gainesville, FL, USA.
authors.forename: Karen R
authors.initials: KR
authors.lastname: Sando
authors.affiliation: 2 University of Florida College of Pharmacy, Gainesville, FL, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Zambrano
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001794:Blood Pressure; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin
keywords: family medicine; hemoglobin A1C; pharmacist; rural; type 2 diabetes mellitus