Category: Professional Posters
Purpose: This study was designed to analyze the effectiveness of a comprehensive medication management service on improving health outcomes in a primary care setting. Federally qualified health care centers (FQHCs) are essential in providing care to patients living in underserved areas. Pharmacists integrated into these facilities increase access to healthcare. This study sought to measure the benefit of integrating pharmacists in the primary care team in caring for patients living with diabetes. The primary objective of this study was to decrease hemoglobin A1c (A1C) by 2% or more in patients 18 years or older with diabetes over 12 months.
Methods: Subjects were enrolled in the study if they met the inclusion criteria (diagnosed with type 1 or type 2 diabetes) and had an A1C greater than or equal to 9.0% at baseline. Subjects were subsequently seen by the clinical pharmacy team in collaboration with the medical provider to develop and implement an individualized pharmaceutical care plan. Hemoglobin A1c levels were measured at 3-month intervals during the study. This unique plan included an assessment and plan for medication therapy, gaps in care, and preventive measures. At follow up visits, pharmacists identified and resolved medication issues and associated barriers. The statistical difference between baseline and post-intervention A1C levels was calculated using a paired samples t-test. The α level was set at 0.05. Descriptive statistics were used to summarize findings related to the type and frequency of medication therapy problems identified by the pharmacists. Medication therapy problems (MTPs) were categorized based on the Pharmacy Quality Alliance performance measures grouped into the domains of adherence, efficacy, safety, and indication.
Results: The study enrolled a total of 50 patients. 54% of the patients were female. The age of the participants ranged from 20 years to 77 years old with an average age of 57 years old. The overall average decrease in A1C among study participants post-intervention was 1.33%. (p < .00001). Over 40% of the MTPs identified were in the efficacy domain (e.g., dose too low). The percent of MTPs in the indication, safety, and adherence categories were similar at 17%, 15% and 19% each while 6% were a combination of 2 or more categories.
Conclusion: This study adds to the body of evidence describing the impact of pharmacist interventions on chronic disease state management in FQHCs. Pharmacist-led CMM proved beneficial in managing patients living with diabetes. The significant decrease in A1C demonstrates the value of this service. The sustainability of this service needs to be studied and validated. Limitations of this study include the relatively small sample size and lack of a control group. Further investigation on a larger scale with separate control and test groups is warranted.