Clinical pharmacist visits improve HbA1c for Hispanic adults with type 2 diabetes
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Key takeaways:
- Hispanic adults with type 2 diabetes had a greater drop in HbA1c if they attended a visit with a clinical pharmacist vs. usual care.
- Clinical pharmacist visits were not linked to a change in systolic BP.
Hispanic adults with type 2 diabetes who attended a primary care clinic visit with a clinical pharmacist had a larger drop in HbA1c than those who received usual care, according to a study published in JAMA Network Open.
“Pharmacist and physicians working together to address the unique barriers to care that patients face, across multiple levels, may lead to better outcomes than standard health care,” Kimberly D. Cauley Narain, MD, MPH, PhD, assistant professor in residence in the division of general internal medicine and health services research at the David Geffen School of Medicine at University of California, Los Angeles (UCLA), told Healio. “The change in blood sugar among patients who received this intervention compared with those who did not was equivalent to adding on another diabetes medication.”
Narain and colleagues obtained data from Hispanic adults aged 18 years and older with type 2 diabetes who attended a primary care clinic that was part of UCLA’s UCMyRx initiative. Clinics in the UCMyRx initiative had clinical pharmacists who were trained in motivational interviewing to comanage patients with complex care needs alongside primary care physicians. Electronic health record data was collected for adults who attended at least one visit with a clinical pharmacist at a UCMyRx clinic as well as adults who received usual care and attended at least two visits at a UCLA primary care clinic 2 or more years apart.
HbA1c analysis was limited to adults who had an HbA1c of 8% or higher at least once in the year prior to their pharmacist visit and 14 days after their visit, as well as a follow-up HbA1c measurement 120 to 365 days after their visit. The BP analysis was limited to those with a systolic BP of 140 mm Hg or higher in the year prior to visiting a clinical pharmacist and 14 days after the visit and had a follow-up measurement 120 to 450 days post-visit. Propensity score matching was used to match intervention participants, with two adults receiving usual care.
There were 931 adults with type 2 diabetes included in the study (mean age, 64 years; 59.3% women). There were 396 adults included in the HbA1c analysis and 795 participants included in the systolic BP analysis.
Adults who had at least one clinical pharmacist visit had a greater reduction in HbA1c from baseline to post-visit than adults receiving usual care (beta = –0.46%; 95% CI, –0.84 to –0.07; P = .02). No change was observed for systolic BP. In language-stratified analysis, adults who preferred to speak English had a greater reduction in HbA1c following a clinical pharmacist visit than English speakers receiving usual care (beta = –0.59%; 95% CI, –1.13 to –0.06; P = .03). No HbA1c change was observed for those who preferred to speak a non-English language. No differences in systolic BP were observed in any language subgroups.
“We were surprised to see that patients who preferred to speak English who received the intervention had a bigger drop in their blood sugar than patients who preferred not to speak English,” Narain said.
The median number of face-to-face pharmacist visits and total contacts was not linked to a change in HbA1c or systolic BP. In a sensitivity analysis, no differences in HbA1c and systolic BP were observed for Hispanic adults in the intervention group compared with a group of non-Hispanic white adults who visited with a clinical pharmacist.
Narain said more studies are needed to see if findings are similar at other health care systems that implement similar programs.
For more information:
Kimberly Danae Cauley Narain, MD, PhD, MPH, can be reached at knarain@mednet.ucla.edu.
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