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Impact of a Pharmacist-Managed Diabetes Clinic on Quality Measures
Nadia J. Aneese, PharmD; Alexandra Halalau, MD; Sarah Muench, PharmD; Daniel Shelden, DO; Janna Fett, PharmD; Colleen Lauster, PharmD

Impact of a Pharmacist-Managed Diabetes Clinic on Quality Measures

Nadia J. Aneese, PharmD; Alexandra Halalau, MD; Sarah Muench, PharmD; Daniel Shelden, DO; Janna Fett, PharmD; Colleen Lauster, PharmD
This study evaluated a pharmacist-managed diabetes clinic to determine its impact on diabetes-related quality measures.(For Tables and Figures, please access the PDF on last page.)
Pharmacists in the PMDC follow a specific checklist at the initial appointment to keep track of diabetes standards, such as nephropathy screening, which may have explained the difference between the groups.There were limitations to this study. At the evaluation time points of 3 and 6 months, a smaller amount of follow-up data was available. This may be related to the rate of missed appointments in general, but it also affects the percent of patients reaching the goal. If authors assumed that any patient without data did not reach the goal, the overall number of patients reaching the target A1C would be less. Additionally, as this study was a chart review, the results are dependent upon documentation in the institution’s charting system. Lastly, a snapshot method was used to determine if patients had reached their target BP—a practice that payers use when evaluating HEDIS measures. However, patients may have been at their target immediately before or after the snapshot value, and this may not accurately reflect overall BP control.

Based on this study, areas for process improvement were identified. To improve rates of retinopathy screening, clinic pharmacists are now working with the institution’s eye clinic to better streamline an appointment process for patients with diabetes. Efforts to schedule these annual retinopathy screenings immediately after a clinic visit were initiated. The eye clinic being located within the same building improved coordination of appointments, which may alleviate concerns of transportation, work-related time off, or other matters.

It was noted that many patients in the standard group were referred to the PMDC, however appointments to the PMDC were not made. Improving the referral process will also require coordination with clinic registration to ensure referrals made for the PMDC are carried out. Additional education to the medical residents on the PMDC referral process may improve this.

Conclusion

The addition of a PMDC had a positive effect on the change in A1C of patients with diabetes. A higher percentage of patients in the PMDC were able to reach a target A1C of <8%. Rates of nephropathy screening were also improved with the PMDC. Patients in both groups were ordered appropriate medications in regard to other diabetes standards of care. Overall, retinopathy screening in this patient population is open to improvements. 

Author Information:

Nadia J. Aneese, PharmD, is with Huron Valley Physicians Association of Ann Arbor, Michigan. Alexandra Halalau, MD, is with Beaumont Hospital, Royal Oak, Department of Internal Medicine, Royal Oak, Michigan. Sarah Muench, PharmD, Janna Fett, PharmD, and Colleen Lauster, PharmD, are with Beaumont Hospital, Royal Oak, Department of Pharmaceutical Services, Royal Oak Michigan. Daniel Shelden, DO, is chief resident at Beaumont Hospital, Royal Oak, Department of Internal Medicine.

The authors have no funding sources to disclose.

Corresponding Author: 
Colleen Lauster, PharmD
Colleen.lauster@beaumont.org
Beaumont Hospital, Royal Oak
Department of Pharmaceutical Services
Beaumont Hospital, Royal Oak, Michigan
3601 West 13 Mile Road
Royal Oak, MI 48073

 
References

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA. CDC website. cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed February 15, 2018.

2. National Committee for Quality Assurance. HEDIS 2015 measures. National Committee for Quality Assurance website. ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2015. Accessed March 7, 2018.

3. Nukols TK, McGlynn EA, Adams J, et al. Cost implications to health care payers of improving glucose management among adults with type 2 diabetes. Health Serv Res. 2011;46(4):1158-1179. doi: 10.1111/j.1475-6773.2011.01257.x.

4. Morello CM, Zadvorny EB, Cording MA, et al. Development and clinical outcomes of pharmacist-managed diabetes care clinics. Am J Health Syst Pharm. 2006;63:1325-1331. doi: https://doi.org/10.2146/ajhp050430.

5. Anaya JP, Rivera JO, Lawson K, et al. Evaluation of pharmacist managed diabetes mellitus under a collaborative practice agreement. Am J Health Syst Pharm. 2008; 65:1841-1845. doi: 10.2146/ajhp070568.

6. Kelly C, Rodgers PT. Implementation and evaluation of a pharmacist-managed diabetes service. J Manag Care Spec
Pharm. 2000;6(6):488-493. https://doi.org/10.18553/jmcp.2000.6.6.488.

7. Choe HM, Mitrovich S, Dubay D, Hayward RA, Krein SL, Vijan S. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial. Am J Manag Care. 2005;11:253-260.

8. Leal S, Glover JJ, Herrier RN, et al. Improving quality of care in diabetes through a comprehensive pharmacist-based disease management program. Diabetes Care. 2004;27(12):2983-2984.

9. 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(4):137-142.

10. Dumontier C, Rindfleisch K, Pruszynski J, Frey JJ 3rd. A multi-method intervention to reduce no-shows in an urban residency clinic. Fam Med. 2013;45(9):634-641.
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