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Pharmacist-led clinics improve glucose control, cost savings for patients with type 2 diabetes
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SAN FRANCISCO — Patients with type 2 diabetes treated at pharmacist-led clinics could achieve greater improvements in glycemic control and save more money on medical costs than through primary care alone, according to research presented at the American Diabetes Association’s 74th Scientific Sessions.
“Spending a little more time and money on the front end saves a lot more on the back end,” Candis M. Morello, PharmD, CDE, FCSHP, FASHP, of the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences in La Jolla, said during her presentation. “We empower patients; we give them tools to take control of their diabetes; and they can do it — it’s so exciting to see them do it.”
Using a published regression model and retrospective chart data, Morello and colleagues compared 3-year total medical costs for 85 patients treated at a Diabetes Intense Medical Management (DIMM) Clinic that runs 4 hours per week and 51 patients treated by primary care providers (PCPs) only.
“The DIMM Clinic employs a novel concept of a “tune up” clinic where patient-entered clinical care is coupled with real-time diabetes education in 60-minute visits to help patients achieve glycemic and metabolic control over 3-5 visits within about 6 months. This clinic is a collaborative practice model with a PharmD-CDE and overseen by an endocrinologist,” Morello told Endocrine Today.
Patients were all over age 18 and had type 2 diabetes with HbA1c >8% at first DIMM Clinic or PCP visit. They had been treated for at least 6 months and were similar in gender and presence of hypertension and heart disease. Hyperlipidemia was observed in a higher proportion of DIMM Clinic patients than PCP patients (87% vs. 71%, P=.018).
The investigators defined cost avoidance as the difference between estimated medical costs using initial visit vs. 6-month visit data and primarily reflected change in HbA1c. A sensitivity analysis assumed an increase in the 1 year HbA1c by 1%.
Significantly greater improvement in mean HbA1c values was achieved by DIMM Clinic patients compared with PCP patients (–2.4% vs. –0.2%, P<.001).
Lower 6-month HbA1c values for the DIMM Clinic group (8.1% vs. 9.1%) translated to an average estimated cost avoidance of $9,104 per DIMM Clinic patient over 3 years vs. $1,803 per PCP patient. Sensitivity analysis reduced the 3-year cost avoidance to $6,412 per DIMM Clinic patient, which was still three times greater than the cost avoidance per PCP patient.
Based on a $546,240 estimated 3-year cost avoidance per 60 patients — the current annual patient capacity for DIMM Clinic — benefit-to-cost ratio was $8.81 and return on investment was $7.81 per dollar spent on the DIMM Clinic pharmacist-CDE. With the sensitivity analysis, cost avoidance was $384,720, with $6.21 benefit-to-cost ratio and $5.21 return on investment.
Preliminary data showed no significant change in HbA1c 1 year after patients were discharged from the DIMM Clinic and returned to the primary care provider.
“We provide the tools, and hopefully life-long skills, and teach them what to do with their blood glucose values to help patients control their diabetes,” Morello said. “Time really does save money, and most importantly, it helps our patients and the medical center.” — by Allegra Tiver
For More Information: Morello CM. Abstract 12-OR. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.
Disclosures: Morello reports no relevant disclosures.
Perspective
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Sue McLaughlin, MOL, BS, RD, CDE
Pharmacists are becoming more and more involved in diabetes education. This is because they are really the ones who see patients with diabetes the most due to the frequency of picking up medications.
It is great to see an example of a system that connects with the primary care physicians for referrals so pharmacists can set up an education, in a venue where it is normal for patients to be, and makes a difference in patient outcomes that also carries cost savings.
The concept of a pharmacist-led clinic explores a new model that involves yet another member of the health care team. This is an approach that not only serves to improve the overall knowledge level of patients that a pharmacist sees, but also avoid medical costs.
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