Pharmacists fine tune diabetes clinic with individual care in mind

Patients in the clinic had a 3.2-point decrease in A1C at 6 months

For years, pharmacists at Beaumont Hospital in Royal Oak, MI, have been part of a multidisciplinary diabetes clinic (MDC). But as the emphasis on quality measures through value-based care programs has amped up, the team knew more needed to be done for their patients. A pharmacist-managed diabetes clinic (PMDC) was created to provide a different level of care for patients with diabetes who are considered high risk.

“We called it fine tuning—emphasizing the importance of having the whole team there in addition to pharmacists doing more one-on-one education and getting patients to do more self-management,” said Nadia Aneese, PharmD, one of the participating pharmacists. For her residency project, Aneese led a study measuring the impact of the PMDC on specific quality measures. Results were published in the March 2018 issue of the American Journal of Managed Care.

Clinicians at Beaumont’s outpatient clinic, which houses the MDC and PMDC, needed high scores on the Healthcare Effectiveness Data and Information Set (HEDIS) to achieve official status as a patient-centered medical home. HEDIS is an evaluation tool developed by the National Committee for Quality Assurance that includes defined diabetes care criteria. Pharmacists in the PMDC used the five main targets in these criteria as their measures: A1C testing, A1C control of less than 8%, retinal or dilated eye exam, blood pressure control of less than 140/90 mm Hg, and nephropathy monitoring.

“We focused primarily on A1C because of the short time frame of the study,” said Aneese. All patients with diabetes who were enrolled in the PMDC between January 1, 2015, and September 30, 2015, were included in the study. Thirty-six patients in the PMDC were compared with 74 patients managed by standard clinic care. Overall, patients in the PMDC had a 3.2-point decrease in A1C at 6 months.

Pharmacists in the PMDC, working under a collaborative practice agreement (CPA), took an individualized approach to patient education. Some patients needed more basic education than others—or had never had it. Education also focused on A1C goals and helping patients understand why they needed to check their blood glucose, and how frequently. Medication options and how they work were discussed. “We really wanted patients to be part of the conversation,” said Aneese. The CPA allowed pharmacists to initiate or adjust medication and order appropriate vaccines.

Education about lifestyle included overall goals for patients and how to achieve them step by step.

Depending on the patient, pharmacists also reviewed these topics during subsequent appointments. Aneese said it was helpful that PMDC pharmacists were able to follow up more often with patients.

Janna Fett, PharmD, BCACP, one of the pharmacists working in the PMDC, attributes the model’s success to the personalized relationships pharmacists developed with referred patients.

“We were able to focus primarily on diabetes self-management and truly work with the patient at an individual level to not only increase their knowledge of the disease and prescribed medications but also set health-related goals,” said Fett.

For the full article, please visit www.pharmacytoday.org for the June 2018 issue of Pharmacy Today.