Evaluating glycemic control for patient-aligned care team clinical pharmacy specialists at a large veterans affairs medical center

Jessica Gardea, James Papadatos, Richard Cadle

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Management of diabetes mellitus (DM) remains a challenge in the US, as almost half of patients with diabetes are uncontrolled with a hemoglobin A1c (HbA1c) >7%. Over the last decade there has been increasing evidence supporting the integration of Clinical Pharmacy Specialists (CPSs) to multidisciplinary medical teams which have demonstrated improved glycemic control and better clinical outcomes in the primary care setting. Objectives: The primary objective of this study was to evaluate the change in HbA1c levels in patients with diabetes followed by a CPS. The secondary objectives of this study were to evaluate the percent of patients who reached American Diabetes Association (ADA) goal HbA1c (<7%) by study conclusion and evaluate documentation of hypoglycemic events in progress notes. Methods: A retrospective chart review evaluating glycemic control was conducted on patients with DM managed by a CPS at a large Veterans Affairs Medical Center. Patients with a diagnosis of Type 1 or Type 2 DM with a baseline HbA1c ≥9% and at least three CPS visits over twelve months were included in this study. Patients with cognitive impairment as documented by ICD-9 codes or with less than three CPS visits over twelve months were excluded. Results: A sample of 79 patients was identified. The mean HbA1c declined by 1.5 percentage points (from 10.6%, SD=1.4 to 9.1%, SD=1.5) after one year. No patients reached ADA goal of HbA1c <7% at study conclusion, however 23% of patients reached a less stringent goal of <8%. All CPS progress notes assessed episodes of hypoglycemia and provided education, and no hospitalizations were related to hypoglycemic events. Conclusions: Integration of a CPS into a veteran’s diabetes care was associated with improved outcomes and enhanced hypoglycemic education. Our results advance the existing literature by demonstrating a positive association between CPS intervention and improved glycemic control in a complex veteran population.

Original languageEnglish
Article number1164
JournalPharmacy Practice
Volume16
Issue number2
DOIs
StatePublished - 30 Jun 2018

Fingerprint

Patient Care Team
Veterans
Medical problems
Hemoglobins
Hypoglycemic Agents
International Classification of Diseases
Education
Diabetes Mellitus
Hypoglycemia
Documentation
Type 2 Diabetes Mellitus
Primary Health Care
Hospitalization

Keywords

  • Ambulatory care
  • Diabetes mellitus
  • Patient care team
  • Patient outcome assessment
  • Pharmaceutical services
  • Pharmacists
  • Retrospective studies
  • Texas

Cite this

@article{6c3ffe4132364473972bf30afaaa2b7a,
title = "Evaluating glycemic control for patient-aligned care team clinical pharmacy specialists at a large veterans affairs medical center",
abstract = "Background: Management of diabetes mellitus (DM) remains a challenge in the US, as almost half of patients with diabetes are uncontrolled with a hemoglobin A1c (HbA1c) >7{\%}. Over the last decade there has been increasing evidence supporting the integration of Clinical Pharmacy Specialists (CPSs) to multidisciplinary medical teams which have demonstrated improved glycemic control and better clinical outcomes in the primary care setting. Objectives: The primary objective of this study was to evaluate the change in HbA1c levels in patients with diabetes followed by a CPS. The secondary objectives of this study were to evaluate the percent of patients who reached American Diabetes Association (ADA) goal HbA1c (<7{\%}) by study conclusion and evaluate documentation of hypoglycemic events in progress notes. Methods: A retrospective chart review evaluating glycemic control was conducted on patients with DM managed by a CPS at a large Veterans Affairs Medical Center. Patients with a diagnosis of Type 1 or Type 2 DM with a baseline HbA1c ≥9{\%} and at least three CPS visits over twelve months were included in this study. Patients with cognitive impairment as documented by ICD-9 codes or with less than three CPS visits over twelve months were excluded. Results: A sample of 79 patients was identified. The mean HbA1c declined by 1.5 percentage points (from 10.6{\%}, SD=1.4 to 9.1{\%}, SD=1.5) after one year. No patients reached ADA goal of HbA1c <7{\%} at study conclusion, however 23{\%} of patients reached a less stringent goal of <8{\%}. All CPS progress notes assessed episodes of hypoglycemia and provided education, and no hospitalizations were related to hypoglycemic events. Conclusions: Integration of a CPS into a veteran’s diabetes care was associated with improved outcomes and enhanced hypoglycemic education. Our results advance the existing literature by demonstrating a positive association between CPS intervention and improved glycemic control in a complex veteran population.",
keywords = "Ambulatory care, Diabetes mellitus, Patient care team, Patient outcome assessment, Pharmaceutical services, Pharmacists, Retrospective studies, Texas",
author = "Jessica Gardea and James Papadatos and Richard Cadle",
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Evaluating glycemic control for patient-aligned care team clinical pharmacy specialists at a large veterans affairs medical center. / Gardea, Jessica; Papadatos, James; Cadle, Richard.

In: Pharmacy Practice, Vol. 16, No. 2, 1164, 30.06.2018.

Research output: Contribution to journalArticle

TY - JOUR

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AU - Papadatos, James

AU - Cadle, Richard

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AB - Background: Management of diabetes mellitus (DM) remains a challenge in the US, as almost half of patients with diabetes are uncontrolled with a hemoglobin A1c (HbA1c) >7%. Over the last decade there has been increasing evidence supporting the integration of Clinical Pharmacy Specialists (CPSs) to multidisciplinary medical teams which have demonstrated improved glycemic control and better clinical outcomes in the primary care setting. Objectives: The primary objective of this study was to evaluate the change in HbA1c levels in patients with diabetes followed by a CPS. The secondary objectives of this study were to evaluate the percent of patients who reached American Diabetes Association (ADA) goal HbA1c (<7%) by study conclusion and evaluate documentation of hypoglycemic events in progress notes. Methods: A retrospective chart review evaluating glycemic control was conducted on patients with DM managed by a CPS at a large Veterans Affairs Medical Center. Patients with a diagnosis of Type 1 or Type 2 DM with a baseline HbA1c ≥9% and at least three CPS visits over twelve months were included in this study. Patients with cognitive impairment as documented by ICD-9 codes or with less than three CPS visits over twelve months were excluded. Results: A sample of 79 patients was identified. The mean HbA1c declined by 1.5 percentage points (from 10.6%, SD=1.4 to 9.1%, SD=1.5) after one year. No patients reached ADA goal of HbA1c <7% at study conclusion, however 23% of patients reached a less stringent goal of <8%. All CPS progress notes assessed episodes of hypoglycemia and provided education, and no hospitalizations were related to hypoglycemic events. Conclusions: Integration of a CPS into a veteran’s diabetes care was associated with improved outcomes and enhanced hypoglycemic education. Our results advance the existing literature by demonstrating a positive association between CPS intervention and improved glycemic control in a complex veteran population.

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