Jonathan Little, PharmD
Research published in JAMA demonstrates the value that a pharmacist-led intervention provides to Hispanic patients with T2D.
Hispanic individuals with T2D are more likely than non-Hispanic white individuals to develop diabetes-related complications such as end-stage kidney disease and retinopathy. The study, published online on September 28, 2023, examined the impact that a pharmacist-led intervention can have on a patient’s A1C and systolic BP.
Researchers found having at least one pharmacist visit was associated with a significant reduction in A1C and no significant change in systolic BP for patients participating in the study.
“The magnitude of the improvement in blood sugar level in this subgroup was consistent with what is seen with starting some diabetes medications,” said lead author Kimberly Narain, MD, PhD, MPH, from the department of medicine at the University of California, Los Angeles (UCLA). The study involved patients of primary care clinics affiliated with UCLA who self-reported Hispanic ethnicity.
Improvement in blood glucose levels was particularly true for individuals with an English-language preference who were younger and had fewer comorbidities relative to individuals with a non-English preference.
“Consequently, it seems like there is a real opportunity for prevention of diabetes-related morbidity and mortality with this type of intervention,” Narain said.
Clinical pharmacists
The UCMyRx initiative involved embedding clinical pharmacists trained in motivational interviewing into primary care practices to co-manage patients with complex care needs along with their primary care physicians.
In these settings, pharmacists meet with patients to review vital signs and laboratory results, order tests, perform medication reconciliation, assess medication adherence, and provide a personally tailored intervention to improve medication adherence. These assessments are communicated to the primary care provider who then reviews and documents agreement or disagreement with the pharmacist in the EHR. The pharmacist is then able to directly prescribe or discontinue medications and order lab tests as needed.
The researchers compared those patients who visited with a UCMyRx pharmacist to those who did not.
In addition to a reduction in A1C for participating patients, the researchers’ analyses, based on visit frequency, suggested a negative association between A1C and UCMyRx exposure with a single UCMyRx pharmacist visit. Meaning, as little as one visit with a UCMyRx pharmacist may improve a patient’s average blood glucose level.
Interventions for Hispanic patients
University of California researchers were prompted to look into the reasons Hispanic primary care patients had less favorable diabetes control relative to other racial and ethnic groups across their academic medical centers in the University of California Health System.
“Differences in medication adherence came up as a possible contributing factor,” said Narain. “When we surveyed the literature for interventions to improve medication adherence among Hispanic patients with diabetes, we did not come across any interventions focused on Hispanic patients receiving care in academic medical centers. Instead, most interventions targeted Hispanic patients in safety net clinics and federally qualified health centers, which differ in important ways from the Hispanic patients served in UC Health.”
Ultimately, they wanted to identify an intervention that had the potential to improve diabetes control for Hispanic patients receiving care in UC Health. This led them to UCMyRx, which has shown benefit among other subpopulations with diabetes at UCLA, according to Narain.
The authors noted that the reduction in A1C of 0.46%, as found in the study, is consistent with what other research has concluded for insulin initiation, and underscores the benefit that having a visit with a pharmacist may have for patients with diabetes.
In addition, the authors acknowledged that according to economic models, this 0.46% reduction in A1C may significantly reduce microvascular and macrovascular complications among patients with diabetes.
Recognizing the value that pharmacists can provide, Narain and coauthors said that a broader scope of practice for pharmacists is needed for wider dissemination of similar interventions.
UCMyRx pharmacists are authorized, per California state law, to bill for consultation services, which is a vital aspect of being able to provide these services for patients. ■