Category: Professional Posters
Purpose: The purpose was to conduct pharmacotherapeutic management of patients in the outpatient setting in order to improve diabetes management. A CMR program was implemented at select ambulatory care sites within our healthcare system. This review identified and addressed medication-related concerns to optimize diabetes management and attain positive patient outcomes.
Methods: This prospective review included patients 18 years of age and older with uncontrolled diabetes characterized by A1c greater than or equal to 9 percent. Patients were excluded if their diabetes care was managed by endocrinology, they had been lost to follow up (less than two billable visits in the past year), or if they were on hospice. The study was approved by the investigation review board. Evaluation assessed for therapeutic duplications, potential interactions, side effects, opportunity for therapy optimization, pharmacoeconomic issues and adherence concerns. All data was collected through the outpatient electronic health record. The primary outcome was the number of recommendations identified through CMR. Secondary outcomes included type of interventions made, percent of recommendations accepted, and reasons for rejection.
Results: A total of 76 patients were identified at 2 outpatient clinics. Of these, 51 patients were unable to be contacted and a total of 58 recommendations were made on the remaining 25. Out of the 58 interventions, 84 percent were accepted by providers and 2 percent were rejected with the remaining 14 percent still pending. Recommendations fell into 3 major categories: therapy optimization, cost/generic options, and adherence concerns. One recommendation was rejected because the provider felt the patient would not benefit from additional education during one of their follow-up visits.
Conclusion: CMR was shown to be highly effective in identifying appropriate medication interventions in order to optimize patient care. This study provided the framework to move pharmacists into other outpatient sites in the healthcare setting to assist in targeting inappropriate prescribing in the elderly.