 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Daniel G. Garrett, MS, FASHP, American Pharmacists Association Foundation, 2215 Constitution Avenue, NW, Washington, DC, DC 20037, 336-327-4000, dgarrett@aphanet.org
Objective: To describe the outcomes for up to 5 years following the initiation of community-based pharmaceutical care services (PCS) for patients with diabetes and to ascertain patient's, provider's and manager's perceptions of the factors that contributed to the success of the Asheville Project.
Design: Quasi-experimental, longitudinal pre-post cohort study and focus groups and interviews with patients, providers and managers.
Setting: Twelve community pharmacies in Asheville, N.C., and two employers, The City of Asheville and the Mission St. Joseph°¦s Health System(MSJ).
Patients and Other Participants: Patients with diabetes covered by self-insured employers' health plans. Community pharmacists trained in a diabetes certificate program and reimbursed for PCS, diabetes educators, and managers employed by the City of Asheville and the MSJ
Interventions: Education by certified diabetes educators, long-term community pharmacist follow-up using scheduled consultations, clinical assessment, goal setting, monitoring, and collaborative drug therapy management with physicians. Patients received incentives of waived medication co-pays to participate in the program and community pharmacists were reimbursed for PCS. A trained facilitator conducted the focus groups and interviews.
Main Outcome Measures: Changes in glycosylated hemoglobin (A1c), serum lipid concentrations, changes in diabetes-related and total medical utilization costs over time and perceptions of focus groups and interviewees.
Results: Mean A1c decreased at all follow-ups, with more than 50% of patients demonstrating improvements at each time. The number of patients with optimal A1c values (< 7 %) also increased at each follow-up. More than 50% showed improvements in lipid levels at every measurement. Costs shifted from inpatient and outpatient physician services to prescriptions, which increased significantly at every follow-up. Total mean direct medical costs decreased by $1,200 to $1,872 per patient per year compared with baseline. Days of sick time decreased every year (1997-2001) for one employer group, with estimated increases in productivity estimated at $18,000 annually. Focus group participants were enthusiastic with their experience with the project. Patients valued the on-going relationships with the pharmacists, the incentives they received and as a result of the program the patients felt more in control of their diabetes. Providers indicated it takes a comprehensive long term approach to help patients manage their diabetes and managers indicated the aligned incentives and the community based approach were keys to the program success.
Conclusion: Patients with diabetes who received ongoing community based PCS maintained improvement in A1c over time, and employers experienced a decline in mean total direct medical costs
Learning Objectives:
Keywords: Community-Based Health Care, Diabetes
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Handout (.ppt format, 1129.5 kb)