Category: Professional Posters
Purpose: Multiple studies have demonstrated the positive impact of pharmacists on patient outcome measures for diabetes. However, current evidence to correlate patient-specific clinical and demographic factors with these outcome measures remains limited. The primary objective of this study is to identify if there are unique patient factors that may contribute to successfully lowering hemoglobin A1c (HgbA1c) to a target of less than 7 percent at discharge for patients managed by clinical pharmacists practicing under collaborative agreements. Study findings may support clinical pharmacy services by identifying patients who are more likely to succeed in diabetes management and help identify barriers to success.
Methods: A retrospective chart review was completed of 419 patients referred to clinical pharmacy collaborative drug therapy management clinics for type 2 diabetes. Patients included in this study were at least 18 years old, had a diagnosis of type 2 diabetes, had a documented HgbA1c goal of less than 7 percent at the first clinic visit and had a HgbA1c greater than 7 percent within 6 months of the first clinic visit. All patients were enrolled and discharged from follow-up with the clinical pharmacist between January 1, 2017 and January 1, 2019. For all patients, data were extracted from the electronic medical record at the initial clinic visit and discharge. Data elements included demographics, HgbA1c, duration of diabetes, diabetes medications, preferred pharmacy, medical insurance, use of other specialist providers, concomitant documented diagnoses, smoking status, number of pharmacy face-to-face clinic visits attended, missed, or cancelled, and number of non-face-to-face follow-ups via telephone or electronic messaging system. This study was approved by the MCPHS University Institutional Review Board.
Results: A total of 228 patients met the inclusion criteria. Eighty-one patients achieved clinical success (HgbA1c less than 7% within 180 days before or after discharge) and 144 were clinical failures (HgbA1c greater than 7% within 180 days before or after discharge). During the study period, several independent factors were predictive of patient success. These factors included Asian ethnicity (odds ratio (OR): 19.32), initial HgbA1c of 7 to 7.9% (OR: 2.34), duration of time enrolled in a pharmacist run clinic being 5 to 6 months (OR: 2.06) and discharged on a glucagon-like peptide-1 receptor agonist (GLP1-RA) (OR: 1.83). Factors that were predictive of failure were black or African American ethnicity (OR: 0.42) and discharged on a sodium-glucose cotransporter-2 (SGLT-2) inhibitor (OR: 0.27).
Conclusion: Overall this study found clinical and demographic factors that are associated with achieving a HgbA1c of less than 7 percent at discharge in a clinic managed by clinical pharmacists practicing under collaborative agreements. Factors associated with clinical success include Asian ethnicity, initial HgbA1c of 7 to 7.9%, enrolled in clinic for 5 to 6 months, and discharged on a GLP1-RA. Independent factors associated with clinical failure include black or African American ethnicity, and discharged on a SGLT-2 inhibitor. These results will further assist pharmacist in determining factors that may impact glycemic control in patients within a pharmacist run diabetes clinic.