A Unique Collaborative Practice Approach to Diabetes Health Management
Amie D. McCord, Pharm.D., BCPS, CDE*, Rami Rihani, Pharm.D., Charles Derus, M.D.
Dreyer Medical Clinic
*Midwestern University Chicago College of Pharmacy
Diabetes Mellitus (DM) is known to cause significant morbidity and mortality as well as contribute substantially to the overall cost of health care. Historically, management of DM has been suboptimal in the primary care setting. Dreyer Medical Clinic in conjunction with Midwestern University Chicago College of Pharmacy implemented a diabetes health management program (DHMP) to address this issue. The purpose of our program is to improve the care of patients with DM through utilization of an interdisciplinary approach to care including medication management by clinical pharmacists.
Description of the Program
The DHMP is based on collaboration between clinic administration, the local College of Pharmacy, primary care physicians (PCPs), clinical pharmacists, registered nurses (RNs), and registered dieticians (RDs). Patients are enrolled in the program primarily through PCP referral. Once enrolled, patients are seen by a nurse educator, dietician, and clinical pharmacist. Clinical pharmacist interventions include disease and medication education as well as comprehensive medication management through collaborative practice agreements held with PCPs. The DHMP was implemented in October, 2001. Annual evaluations are conducted to assess clinical improvement for enrolled patients.
Experience with the Program
The following results represent a retrospective review of 707 patients enrolled between April, 2002 and April, 2004. Patients with complete baseline and follow-up data were included. The mean number of days between baseline and follow-up values was 140 ± 62. Eighty-four percent of enrolled patients were diagnosed with Type 2 DM, 69% met the National Cholesterol Education Program (NCEP) criteria for metabolic syndrome, and 51% were male. The mean baseline A1c was 8.9% ± 2.0% and the mean follow-up A1c was 7.4% ± 1.34% (p<0.001). At baseline, only 18% of enrolled patients were at or below the American Diabetes Association (ADA) established A1c goal of 7%, while 48% achieved this goal after 6 months of follow-up (p<0.001). Lipid values improved for enrolled patients, with 44% achieving the ADA and NCEP established LDL goal of < 100 mg/dL after six months of follow-up, an increase from 25% who had achieved the goal at baseline (p<0.001). Adherence to preventive care measures also significantly improved from baseline to follow-up. Annual eye and foot exams had a relative increase of 21% (p<0.05) and 19% (p<0.05), respectively. Urine microalbumin screening increased from 51% at baseline to 78% at follow up (p<0.05) and patients prescribed an Angiotensin Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) increased 14% (p<0.05). Daily aspirin use for cardiovascular protection increased from 42% at baseline to 80% at follow-up (p<0.05).
The DHMP's unique collaborative approach to diabetes management has resulted in significant clinical improvement for enrolled patients. In the four years since implementation of the program, the patient population and personnel have grown significantly. The program continues to be a valuable service offered to both patients and physicians, as evidenced by continuous new patient enrollment and the results of annual evaluations of clinical outcomes.
View a pdf of the poster from the Midyear Meeting (3.9mb).