Pharmacists help optimize care of patients with type 2 diabetes

When cared for by a primary care team with a pharmacist, patients with type 2 diabetes may experience better blood pressure management, decreased cardiovascular risk, an improved metabolic profile and incur lower costs related to treatment.

“Pharmacists are trained to optimize medication management, especially when regimens become complex,” Scot H. Simpson, PharmD, of the faculty of pharmacy and pharmaceutical services at University of Alberta, Canada, and colleagues wrote in a recent study in Diabetes Care. “Addition of pharmacists to inpatient services and specialty clinics can improve outcomes and lower total medical costs.”

Improved BP control

In the study by Simpson and colleagues, 37% of patients with type 2 diabetes who received care from a team with a pharmacist lowered their systolic BP by at least 10% after 1 year, whereas only 23% of patients who received usual care achieved that target. According to the researchers, this positive effect was even more pronounced among patients who had diabetes and poorly controlled hypertension at baseline: Systolic BP improved by 13.9 mm Hg in the pharmacist care group vs. 6.7 mm Hg in the usual-care group.

The study compared outcomes among patients with type 2 diabetes who were randomly assigned to collaborate care with a pharmacist (n=131) or usual care (n=129). On average, the patients were aged 59 years and were overweight with a BMI of 32.5. Average diabetes duration was 5.5 years and baseline BP was 129.4 mm Hg/74.1 mm Hg, according to baseline characteristics.

One-year follow-up by telephone or in person also revealed that patients who received care from a team with a pharmacist were more likely to achieve considerable reductions in predicted 10-year risk for CV events (2.7%) compared with a usual-care team (1.2%).

“Working in collaboration with the patient, primary care physician and other health care professionals, pharmacists can have a significant, positive impact on [BP] management in type 2 diabetes,” the researchers concluded.

Collaborative care

Pharmacists’ participation in the management of patients with type 2 diabetes has also been associated other benefits.

A study published in the Journal of the American Pharmacists Association in 2009 revealed a significant 1.1% decrease in HbA1c after 1 year, as well as improvements in accompanying parameters such as BMI, BP, LDL and HDL levels and triglycerides, among patients who participated in a pharmacist-led program.

“Our results show that enhancing the patient’s access to care through collaborative physician-pharmacist relationships can yield lower blood glucose levels, improve the overall metabolic profile and reduce costs to the payer,” study researcher Erin Slazak, PharmD, clinical assistant professor of pharmacy practice at the University of Buffalo in New York and board certified pharmacotherapy specialist, said in a press release.

Slazak and colleagues examined the pharmacist-led MedSense program, which was developed in collaboration with a regional primary care group. The program included diabetes education, patient evaluations and offered recommendations to health care providers.

Data show that monthly costs per patient also declined by about $212 — or $2,500 per year.

“We know there’s a long-term clinical and economic benefit to pharmacists working directly with patients and we think that can continue to grow,” said study researcher Scott V. Monte, PharmD, clinical assistant professor of pharmacy practice at the University of Buffalo and director of Diabetes and Cardiovascular Research CPL Associates LLC. “Pharmacists can help achieve better outcomes if given the chance.” – by Melissa Foster

For more information:

• Monte SV. J Am Pharm Assoc. 2009;49:200-208.
• Simpson SH. Diabetes Care. 2011;34:20-26.

Disclosures: Monte, Simpson and Slazak report no relevant financial disclosures.

June Felice Johnson

This study was well-designed and highlighted the value of two experienced CDE pharmacists in collaboration with physicians to reduce short-term CV risk in a sample of patients with diabetes in a primary care network in Canada. The positive patient outcomes in the pharmacist intervention group were a 3% decrease in predicted 10-year CVD risk and a 14% absolute difference in greater odds of achieving the primary outcome of at least a 10% reduction in systolic BP after 1 year. These findings show that evidence-based collaborative approaches, integrated within a primary care medical home model and including a pharmacist, can reduce CV risk burden by reinforcing therapeutic approaches to achieve treatment targets. The new Center for Medicaid and Medicare Innovation provides incentives for similar research aimed at improving collaborative care models and care coordination to improve patient outcomes.

– June Felice Johnson, PharmD, FASHP, BC-ADM

Professor of Pharmacy Practice

Chair, Clinical Sciences Department, Drake University College of Pharmacy & Health Services

Disclosure: Johnson reports no relevant disclosures.

The studies published by Monte and Simpson highlight the impact of pharmacists' expertise and care on improving diabetes health outcomes and reducing costs. Pharmacists provide high-quality, highly accessible, medication-related care in a variety of settings, including clinics, hospitals, nursing homes, grocery stores and more traditional community pharmacies. The education and training of today's pharmacists is focused on pharmacologic safety and efficacy as well as the communiation, instructional ability and motivational skill to promote self-management of conditions like diabetes and to achieve positive outcomes. Although product support is essential in diabetes care and a more traditional responsibility of pharmacists, studies like these raise a critical awareness that pharmacists' expertise in collaboration with the patient and their other care providers is pivotal to assure safe, effective medication outcomes and health promotion. The continued shift of pharmacists into these more patient-focused care services is an important step for the health care system and diabetes care.

– Peggy Odegard, BS, PharmD, CDE

Assistant Professor, School of Pharmacy, University of Washington

Disclosure: Odegard reports no relevant financial disclosures.