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Abstract:
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Diabetes mellitus is a group of metabolic disorders caused by a relative or absolute lack of insulin . Currently , 23 .6 million Americans have diabetes . Diabetes can lead to serious microvascular and macrovascular complications , such as cardiovascular disease , blindness , kidney disease , lower -limb amputations , and premature death . Due to the potential cardiovascular complications and the high prevalence of co -morbid hypertension and /or hyperlipidemia in patients with diabetes , diabetes management should include close monitoring of blood glucose , blood pressure , and cholesterol levels .
Medical management of diabetic patients is costly ; approximately 1 in every 10 health care dollars is currently spent treating diabetes . Studies have shown that in chronic conditions such as diabetes , increased medication use results in demonstrable improvements in health outcomes , reduced hospitalization rates , and decreased direct health care costs . To date no studies have evaluated the impact of a pharmacist -led intervention on diabetic medication adherence .
The purpose of this investigation was to analyze the impact of a pharmacist -led medication management program on medication adherence and pharmacy costs and to evaluate clinical measures of diabetes , hypertension , and hyperlipidemia . This study was a quasi -experimental , longitudinal , pre -post study , with a control group . Scott & White Health Plan (SWHP ) patients with diabetes (type 1 or type 2 ) , poor glycemic control (most recent A1C >7 .5 % ) , and living within 30 miles of participating pharmacies were invited to participate in the intervention which consisted of monthly appointments with a clinical pharmacist and a co -payment waiver for all diabetes medications and testing supplies . A total of 118 patients met study inclusion criteria and were enrolled in the intervention between August 2006 and July 2008 . Intervention patients were matched on sex and age to SWHP patients with poor diabetes control living more than 30 miles from a participating pharmacy . To measure the impact of the intervention , medical and pharmacy data were evaluated for one year before and after the study enrollment date .
A significant difference was seen in the percentage of patients with type 1 diabetes in the intervention group (14 ) and the control group (3 ) . The medication management program significantly improved A1C levels in intervention patients relative to controls ( -1 .1 % vs . 0 .6 % ) and was more effective in lowering A1Cs in type 2 diabetics than type 1 patients . Although the generalized linear model did not show that the intervention significantly improved the percentage of patients achieving the ADA goal A1C of <7 % compared to controls , the multivariate logistic regression , which controlled for factors such as diabetes type , showed that patients participating in the intervention were 8 .7 times more likely to achieve the A1C goal . Persistence with diabetic medications and the number of medications taken significantly increased in the intervention group ; however , adherence rates , as measured by medication possession ratio (MPR ) , did not significantly improve relative to controls . The expenditure on diabetic medications and testing supplies increased substantially more in the intervention group than in the control group .
The percentage of patients adherent with antihypertensive medications (MPR ≥80 % ) increased from 76 % to 91 % in the intervention group and decreased from 68 % to 63 % in the control group (P <0 .05 ) ; no significant difference in blood pressure control was observed . For hyperlipidemia medications , adherence and persistence increased and pharmacy costs decreased in both groups , likely due to the introduction of the first generic HMG -CoA reductase inhibitor into the market during the study period . Future research is needed on the impact of the intervention on medical resource utilization and costs . |