Diabetes: The Impact of Clinical Pharmacy Services Integrated into Medical Homes on Diabetes-Related Clinical Outcomes

Abstract

Background: Pharmacist services have expanded in the US health-care system from traditional roles to include comprehensive clinical services, but many studies lack comparison groups to evaluate outcomes of these clinical services. Objective: To evaluate the clinical outcomes of uninsured or underinsured patients with type 2 diabetes who received care from pharmacists in local “safety net” clinic medical homes compared to outcomes of patients from clinics receiving usual care without the services of clinical pharmacists. Methods: Pharmacists provided comprehensive pharmacy services in safety net clinic medical homes for uninsured patients in a major urban city. Referred patients had poor diabetes control (hemoglobin A1c [A1C] >9%). Pharmacists conducted comprehensive evaluations of medications, made adjustments, monitored adherence, and provided education and follow-up. Intervention patients were compared to similar patients who were receiving usual care but were not seen by a pharmacist. Outcomes evaluated were the change in A1C levels and achievement of treatment goals. Data were derived from chart reviews retrospectively. Multivariate least-squares and logistic regression models were used to estimate the impact of the intervention. Results: Two hundred twenty-two intervention and 262 control patients were evaluated. Patients receiving care from pharmacists had adjusted A1C levels reduced by 1.38% relative to usual care, increasing the likelihood of achieving an A1C <7% by 3-fold (p < 0.001 for both estimates). Conclusions: The integration of clinical pharmacy services into safety net medical homes was associated with improvement in clinical outcomes of patients with diabetes.