Impact of Physician-pharmacist Collaboration on Diabetes Outcomes and Health Care use

Melissa C. Norton, MS, PharmD; Meghan E. Haftman, PharmD, BCPS; Lyndsey N. Buzzard, PharmD, BCACP

Disclosures

J Am Board Fam Med. 2020;33(5):745-753. 

In This Article

Abstract and Introduction

Abstract

Objective: To evaluate the impact of physician–pharmacist collaboration for disease-state management on diabetes outcomes in primary care by comparing outcomes between physician-managed care and pharmacist collaborative care.

Methods: A retrospective, observational cohort study was conducted at Ascension Medical Group Via Christi, P.A. from January 1, 2016 to June 30, 2018. Health outcomes were analyzed in 385 patients with diabetes mellitus collaboratively managed by a physician and pharmacist (collaborative care group). Similar patients managed by physician only (usual care group) were matched to the collaborative care group using nearest neighbor matching. The primary outcome compared glycosylated hemoglobin (HbA1c) change between collaborative care and usual care groups at 12 months.

Results: The mean change in HbA1c decreased by 1.75% in the collaborative care group and 0.16% in the usual care group (P < .0001). The usual care group had a larger number of patients with HbA1c less than 8% at follow-up (P = .0049). Additional outcomes included decrease in total cholesterol (P = .0023), triglycerides (P = .0016), and an increase in PPSV23 pneumococcal vaccinations (P = .0255) in the collaborative care group. The usual care group had an increase in PCV13 pneumococcal vaccinations (P = .0075). Both emergency department visits (P = .0162) and hospitalizations (P = .0225) decreased significantly in the collaborative care group, estimating total savings of $633,015.

Conclusions: The collaboration of pharmacists and physicians in the primary care setting is associated with improved diabetes outcomes and substantially reduces costs related to decreased health care use.

Introduction

The role of pharmacists in the outpatient, nonacute care setting has expanded from the traditional dispensing roles in community pharmacies to a clinical role with direct patient care responsibilities within various ambulatory care settings, including primary care clinics.[1,2] In many collaborative care models within a primary care group practice, clinical pharmacists are embedded in the practice and are acknowledged as a member of the primary care team.[3] Pharmacists within the primary care setting practice in collaboration with physicians and provide clinical pharmacy services that may include counseling and medication education, comprehensive medication management, chronic care management, and population health management for a variety of disease states.[2–13] As of 2016, 48 states in the United States allow pharmacists and prescribers to enter into a collaborative practice agreement, although specific restrictions and regulations vary by state.[14] Collaborative practice agreements provide pharmacists the ability to manage chronic disease states in collaboration with physicians to improve patient outcomes and patient satisfaction.[5,14–16]

The involvement of clinical pharmacists in direct patient care has been shown to improve clinical outcomes in many chronic disease states, including but not limited to diabetes, hypertension, and dyslipidemia.[2,6–9,12,13,16–20] Data also supports that clinical pharmacy services improve provider work-life[21] and reduce health care costs.[12,13,16,17,22,23] Matzke et al[17] found that the inclusion of clinical pharmacists in a collaborative care model demonstrated significant improvements in glycosylated hemoglobin, blood pressure, low-density lipoprotein (LDL) cholesterol, and total cholesterol in the collaborative care group compared with the usual care group. The study also revealed that hospitalizations in the collaborative care group were reduced by 23.4%, yielding an estimated cost savings of $2619 per patient and a return on investment of 504%.[17]

In an effort to decrease health care costs, enhance patient experiences, and improve outcomes, a team-based approach to direct patient care has been acknowledged as an important component to improve health care quality, with pharmacists recognized as a vital member of the health care team.[4,15] With the high prevalence of diabetes, along with the complex medication management and the association of high health care costs, there is a substantial amount of literature to support the involvement of clinical pharmacists in diabetes management to improve and meet clinical goals.[2,6,9,16–19,23–25] Despite the support of published literature showing the effect of clinical pharmacists on improvement of patient outcomes, very few studies compare collaborative pharmacist management to that of physician-only care in a primary care setting. In addition, data for cost evaluation of clinical pharmacy services in a primary care clinic is limited.

The implementation of clinical pharmacy services in primary care at Ascension Medical Group Via Christi, P.A. began in 2012, yet formal evaluation of the impact of those services has yet to be performed. The purpose of this study was to evaluate the impact of physician-pharmacist collaborative disease state management on diabetes outcomes and health care use compared with usual care patients, which consisted of physician-managed care for diabetes.

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