Evaluation of a Pharmacist-Managed Diabetes Program in a Primary Care Setting Within an Integrated Health Care System
Evaluation of a Pharmacist-Managed Diabetes Program in a Primary Care Setting Within an Integrated Health Care System
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DOI：
10.18553/jmcp.2018.24.2.114
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发表时间：
2018-02-01
影响因子：
2.1
通讯作者：
Rashid, Nazia
中科院分区：
文献类型：
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作者：
Benedict, Amanda W.;Spence, Michele M.;Rashid, Nazia
背景：药剂师在管理2型糖尿病患者的治疗和改善患者护理方面发挥着重要作用。药剂师滴定药物；加强患者教育；解决护理差距，如服药依从性、疫苗接种和逾期的健康筛查。通过这些努力和更多的努力，药剂师帮助改善患者护理并实现医疗效果数据和信息集(HEDIS)措施。因此，重要的是通过药剂师对糖尿病治疗的贡献来证明改善了健康结果，这可以提供一个机会来扩大临床药剂师在其他医疗中心和综合卫生保健系统中的实践环境中的作用。目的：通过确定达到HEDIS目标的患者的百分比来评估由药剂师管理的计划在初级保健环境中的效果。完全护理计划(CCP)中的患者由药剂师管理他们的糖尿病治疗，并且倾向评分与普通护理(UC)患者的对照组相匹配。多变量回归分析和COX比例风险模型比较两组间A1c水平的变化和达到A1c目标的时间。结果：CCP患者和UC患者(n=980例/组)的基线特征没有显著差异。与UC患者相比，CCP患者在3个月(OR=2.44，95%CI=1.93~3.10，P<；0.0001)和6个月(OR=1.32，95%CI=1.08~1.61，P=0.007)达到HEDIS目标的可能性显著高于UC患者。慢性阻塞性肺病患者达到A1c目标的时间也明显更快：3.4月比4.6月(P<；0.0001)，即使在控制了协变量后也是如此(HR=1.2495%CI=1.091.41，P=0.001)。在CCP和UC患者中，基线A1c的变化在3个月时分别为-0.95%和-0.54%(P<；0.0001)，在6个月时分别为-1.19%和-0.99%(P=0.008)。结论：与接受常规护理的患者相比，临床药剂师治疗2型糖尿病的患者达到HEDIS目标的比例更高，达到A1c目标的速度更快，A1c在3个月和6个月时较基线水平下降更多。版权所有(C)2018，管理护理学院药房。版权所有。
BACKGROUND: Pharmacists have important roles in managing the therapy of patients with type 2 diabetes and improving patient care. Pharmacists titrate medications; reinforce patient education; and address care gaps, such as medication adherence, vaccinations, and overdue health screenings. Through these efforts and more, pharmacists help to improve patient care and achieve Healthcare Effectiveness Data and Information Set (HEDIS) measures. Thus, it is important to demonstrate improved health outcomes through pharmacist contributions to diabetes management, which can then provide an opportunity to expand the role of clinical pharmacists in other medical centers and practice settings within an integrated health care system.OBJECTIVE: To evaluate the effect of a pharmacist-managed program within a primary care setting by determining the percentage of patients who reached the HEDIS goal of hemoglobin A1c (A1c) = 8.0%. Patients in the Complete Care Program (CCP) had their diabetes therapy managed by a pharmacist and were propensity score matched to a comparison group of usual care (UC) patients. Multivariate regression analyses and a Cox proportional hazards model compared the change in A1c from baseline and the time to A1c goal between the 2 groups.RESULTS: There were no significant differences in baseline characteristics between the CCP and UC patients (n = 980 patients per group). CCP patients were significantly more likely to achieve the HEDIS goal of A1c < 8% at 3 months (OR = 2.44, 95% CI = 1.93-3.10, P < 0.0001) and at 6 months (OR = 1.32, 95% CI = 1.08-1.61, P = 0.007) compared with the UC patients. CCP patients also reached the A1c goal significantly faster: 3.4 months versus 4.6 months (P < 0.0001), even after controlling for covariates (HR = 1.24, 95% CI = 1.09-1.41, P = 0.001). Change in baseline A1c was -0.95% versus -0.54% (P < 0.0001) at 3 months and -1.19% versus -0.99% (P = 0.008) at 6 months for CCP versus UC patients, respectively.CONCLUSIONS: Type 2 diabetes therapy management by clinical pharmacists was associated with a greater percentage of patients achieving the HEDIS goal of A1c < 8.0%, reaching the A1c goal faster, and a greater A1c reduction from baseline at 3 and 6 months of follow-up compared with patients receiving usual care. Copyright (C) 2018, Academy of Managed Care Pharmacy. All rights reserved.