142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

296736
Improving diabetes care through an interdisciplinary, patient-incentivized model in a public health department population

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

B. DeeAnn Dugan, Pharm.D., BCACP , Department of Pharmacy Practice, McWhorter School of Pharmacy Samford University, Birmingham, AL
Roger D. Lander, PharmD, BCPS , McWhorter School of Pharmacy, Samford University, Birmingham, AL
Bryn Manzella, MPH , Jefferson County Department of Health, Birmingham, AL
Katy Collins, Pharm.D.
Ashley Hannings, Pharm.D.
Jessica Skelley, Pharm.D., BCACP
Methods: Patients with uncontrolled type 2 diabetes were identified using the electronic medical record and enrolled between August 2011 and January 2012.  Eligible patients were 18 years or older with a hemoglobin A1C (A1C) > 7% completing a minimum of two visits with the health department physician during the previous year.  Exclusion criteria included inability for self-care, Limited English Proficiency, pregnancy, or no longer being under care of a health department provider.  Patients were scheduled for pharmacist-provided blood glucose meter training, diabetes education and medication management every 4-6 weeks. Patients enrolled in the program were given a glucose meter and testing strips as well as a limited formulary of medications as incentives. The primary outcome measure was change in A1C from baseline. Secondary measures included change from baseline in blood pressure (BP), body mass index (BMI), cholesterol levels, and completion of an eye exam, foot exam, and indicated immunizations. 

Results: Eighty- eight patients were enrolled in the study. Mean age was 49.4 years.   The majority of patients were African- American (85%) and female (80%).  Most were uninsured (76%), with an income below poverty level (59%). Baseline means were: A1C of 9.7%, BMI of 37.0, Low density lipoprotein of 97, and BP of 130.2/82.9. Twenty patients were removed from the study cohort as they never attended clinic beyond the enrollment visit.  Sixty-five patients were included in final results.  At study end, a mean A1C reduction of 0.7% (p=0.010) and BMI reduction of 1 kg/m2 (p=0.005) had been achieved. BP and cholesterol measures were not changed significantly from baseline.  Pharmacist intervention resulted in a 75% improvement in number of eye exams and a 92.3% improvement in foot exams. Of the patients who had not received an annual influenza vaccine at baseline, two of three accepted pharmacist recommendation and received vaccination. Further analysis of the patient cohort by number of visits revealed that patients who attended > 30% of visits achieved a mean A1C reduction of 1.2%.  In contrast, patients who attended < 30% of visits experienced a mean A1C decrease of 0.3%.

Conclusion: While multiple care barriers exist within a public health population due to limited income, inadequate or no insurance and/or transportation, a patient-incentivized, pharmacist-led diabetes clinic, as part of an interdisciplinary care model, facilitates reduction of patient blood glucose and achievement of quality measures for diabetes care.  The amount of impact, however, is predicated by the patient’s ability to regularly attend visits.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Other professions or practice related to public health

Learning Objectives:
Describe the impact of a pharmacist-provided diabetes patient education and management clinic within an interdisciplinary and patient-incentivized care model on patient outcome measures. Relate patient outcomes to diabetes education and management visits attended.

Keyword(s): Diabetes, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator as well as Community Champion for this project since its inception. My interests include diabetes, particularly finding effective education and management strategies in disproportionate share populations. Towards this work, I have worked as a local team lead and national coach for the Patient Safety and Clinical Pharmacy Services Collaborative (PSPC).
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
APhA Foundation Project IMPACT:Diabetes Grant received for project. All monies used to cover patient incentives and educational materials. .

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.