Enhancing diabetes care by adding a pharmacist to the primary care team

被引:72
作者
Ip, Eric J. [1 ,2 ]
Shah, Bijal M. [3 ]
Yu, Junhua [3 ]
Chan, James [4 ]
Nguyen, Lynda T. [5 ]
Bhatt, Deempal C. [6 ]
机构
[1] Touro Univ Calif, Coll Pharm, Dept Pharm Practice, Vallejo, CA 94592 USA
[2] Kaiser Permanente Mt View Med Off, Dept Internal Med, Mountain View, CA USA
[3] Touro Univ Calif, Coll Pharm, Dept Social Behav & Adm Sci, Vallejo, CA 94592 USA
[4] Kaiser Permanente Med Care Program, Pharm Outcomes Res Grp, Oakland, CA USA
[5] Touro Univ Calif, Coll Pharm, Vallejo, CA 94592 USA
[6] Sutter Tracy Med Ctr, Tracy, CA USA
关键词
DISEASE MANAGEMENT; RISK; INTERVENTIONS; MELLITUS; PROGRAM;
D O I
10.2146/ajhp120238
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Purpose. The impact of pharmacist interventions on short-term clinical markers and long-term cardiovascular risk in patients with type 2 diabetes is investigated. Methods. Selected health outcomes were retrospectively analyzed in 147 adults with type 2 diabetes whose care was managed by a team of providers including a pharmacist (the enhanced care group) and a matched sample of patients (n = 147) managed by a primary care physician only (the control group). All patients received services through the same health maintenance organization (HMO). The primary study endpoints were (1) the changes from baseline to 12-month follow-up in glyco, sylated hemoglobin (HbA(1c)), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) values, (2) rates of attainment of HbA(1c), LDL-C and BP goals, and (3) changes from baseline in predicted 10-year risks of coronary heart disease (CHD) and stroke. Results. During the 12-month study period, the mean HbA(1c) value was decreased from 9.5% to 6.9% in the enhanced care group and from 9.3% to 8.4% in the control group (p < 0.001); patients in the enhanced care group were significantly more likely to attain goals for HbA(1c) (odds ratio [OR], 3.9), LDL-C (OR, 2.0), and BP reduction (OR, 2.0) and three times more likely to attain all three goals (OR, 3.2). The estimated 10-year risk of CHD was decreased from 16.4% to 9.3% with enhanced care versus a reduction from 17.4% to 14.8% with usual care (p <0.001). Conclusion. The addition of a pharmacist to an HMO primary care team improved short-term surrogate markers as well as long-term cardiovascular risk in adult patients with type 2 diabetes.
引用
收藏
页码:877 / 886
页数:10
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