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Impact of Clinical Pharmacy Services on Outcomes and Costs for Indigent Patients With Diabetes
Marissa Escobar Quinones, PharmD, CDE; Margaret Youngmi Pio, PharmD, BCPS, CDE; Diem Hong Chow, PharmD, CDE; Elizabeth Moss, PharmD, CDE, BCACP; Jeffrey Lynn Hulstein, PharmD, CDE; Steven Micheal Bo
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Impact of Clinical Pharmacy Services on Outcomes and Costs for Indigent Patients With Diabetes

Marissa Escobar Quinones, PharmD, CDE; Margaret Youngmi Pio, PharmD, BCPS, CDE; Diem Hong Chow, PharmD, CDE; Elizabeth Moss, PharmD, CDE, BCACP; Jeffrey Lynn Hulstein, PharmD, CDE; Steven Micheal Bo
Clinical pharmacy specialists impact patient care through improvements in clinical outcomes for diabetes, hypertension, and dyslipidemia via clinical interventions and promotion of medication adherence.
The annual review of outcomes by the CPSs serves a very important role in demonstrating the benefits of their services in this complex patient population. The outcomes demonstrate positive impacts on A1C, blood pressure, and lipid parameters. In 2007, Machado and colleagues reviewed studies evaluating pharmacists’ interventions and outcomes measured in the management of patients with diabetes. A total of 1145 patients—aged an average of 60.1 years, 53.4% female—found that the weighted average A1C decreased by 1% in a patient population managed by a pharmacist.10 In 2006, another study, by Scott and colleagues, reviewed outcomes in diabetes at a community health center and found a decrease in A1C by 1.7% at the end of a 9-month intervention period.11 This study also noted the patients’ decreased BP and LDL-C. The above studies indicate that clinical pharmacists serve major roles in the management of diabetes, and the services provided by CPSs in this review have continued to correlate to significant reductions in A1C, consistent with other study findings.12-15

Limitations

The purpose of this study was to demonstrate the benefit of CPS services at this institution. The initial CPS project was designed as a quality assurance initiative within the pharmacy department itself. Thus, limitations do exist with this analysis. This study did not include an active comparison group and, therefore, cannot determine if similar improvements in diabetes care would also exist in a control group. Additionally, this study was a retrospective review. The patient population in this review consists of those of lower economic status with various psychosocial issues, and many are without health insurance; thus, our robust results may not be reproducible with other types of patients or settings.

CONCLUSIONS
These outcomes were well received at the institution and have been a stepping stone for this CPS group. The CPSs directly impact patient care by achieving disease-state goals for diabetes, hypertension, and dyslipidemia. In addition, the CPSs have been able to contain the number and cost of medications. It is through CPS interventions, such as active and timely medication changes, patient education, and drug therapy monitoring, that this group of CPSs positively impacted the patients referred for chronic disease state management. From the results seen in this review, the CPSs continue to make consistent and positive impacts in patient care, and subsequently, this group of pharmacists has been able to demonstrate the benefit in utilizing clinical pharmacists under drug therapy management protocols at this institution.

Acknowledgments

The authors would like to acknowledge Carrie Berge, PharmD, MS, Director of Pharmacy Services, and Vivian Johnson, PharmD, MBA, FASHP, Vice President of Pharmacy Services, at Parkland Health & Hospital System for their continued support to our CPS outcomes report and the clinical pharmacy services provided at the institution. Prior presentations of study information include a poster presentation of interim results at the American College of Clinical Pharmacy Annual Meeting; Hollywood, FL; October 2012.

Author Affiliations: Department of Pharmacy Services, Parkland Health & Hospital System (MEQ, MYP, DHC, EM, JLH, SMB, AM), Dallas, TX.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (MEQ, DHC, EM, MYP, JLH, SMB, AM); acquisition of data (MEQ, DHC, EM, MYP, SMB, AM); analysis and interpretation of data (MEQ, DHC, EM, MYP, JLH, SMB); drafting of the manuscript (MEQ, DHC, MYP); critical revision of the manuscript for important intellectual content (MEQ, DHC, MYP, JLH); statistical analysis (MEQ, MYP); provision of patients or study materials (MEQ, EM, MYP, SMB, AM); administrative, technical, or logistic support (MEQ, MYP, SMB); and supervision (MEQ, EM).

Address correspondence to: Marissa Escobar Quinones, PharmD, CDE, Clinical Pharmacy Specialist, Parkland Health & Hospital System, Pharmacy Administration, 5201 Harry Hines Blvd, Dallas, TX 75235. E-mail: Marissa.quinones@gmail.com.
REFERENCES

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15. Davidson MB, Karlan VJ, Hair TL. Effect of a pharmacist-managed diabetes care program in a free medical clinic. Am J Med Qual. 2000;15:137-142.
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