Pharmacist-Based Diabetes Management through a Collaborative Practice Model
Sandra Leal, Pharm.D., CDE, Marisa Soto, Pharm.D., Anthony Felix, R.Ph.,
El Rio Health Center
El Rio Health Center (El Rio) is the primary provider of outpatient medical care to the uninsured and underserved residents of Tucson, Arizona. El Rio currently provides health care to over 4,500 diabetic patients. Medical staff evaluations over the last several years have identified diabetes care as a major target for quality improvement. The lack of patient access to a coordinated disease management program, insufficient personnel and increased patient load have been identified as contributing factors which hinder increased patient access to care and the attainment of optimal clinical outcomes. With the passage of House Bill 2415 by the Arizona legislature in April, 2000, qualified pharmacists working in Community Health Centers (CHC) were specifically identified as being able to initiate, modify and alter drug therapy utilizing written protocols developed in collaboration with physicians practicing in a CHC.
Description of the Program
This provided El Rio the opportunity to utilize a clinical pharmacist to help in the management of diabetes, hypertension and dyslipidemia. Multiple interventions in patients with diabetes, including pharmacist-based disease management programs, have proven successful in both improving disease control and preventing disease complications. This study evaluated the ability of a pharmacist-based disease management program to improve the care of predominately indigent, Spanish-speaking and Native American patients with diabetes and common co-morbid conditions who received care at a federally qualified CHC. Two residency trained clinical pharmacists, one bilingual, were the providers for patients who were referred to the pharmacist-based disease management program by staff physicians.
Experience with the Program
Since August, 2001, over one-thousand patients have been followed in the clinics. Statistically significant improvements were observed between baseline and follow-up values for cholesterol, blood pressure, glucose, and A1C. Changes from baseline to follow-up in the proportion of patents at LDL cholesterol goal, blood pressure goal, A1C goal and in the use of medications known to decrease diabetes complications were significantly improved. A pharmacist-based disease management program for the care of diabetes and frequently associated co-morbid conditions was effective in significantly lowering A1C, blood pressure, and LDLc, in addition to providing near-perfect compliance with national standards for diabetes care.
Implementation of a program such as this has resulted in significant improvements in patient outcomes and in the advancement of the pharmacy profession.
View a pdf of the poster from the Midyear Meeting (3.7mb).