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March 27, 2013
Pharmacists Help Improve Diabetes Control in
Rural African-American Patients Greenville, NC—Poverty-stricken African Americans in rural communities have high rates of type 2 diabetes and traditionally poor outcomes. A new study has found, however, that redesigning diabetes care to include pharmacists and other nonphysician health care providers can lead to “significantly greater intermediate and long-term improvement in glycemic control.” For the study published recently in the Annals of Family Medicine, researchers from East Carolina University in Greenville, NC, selected three rural, fee-for-service, primary care practices to measure the “effectiveness of health professionals–directed interventions, organizational change interventions, and patient-focused interventions” in a previously untested population. In the intervention group, African-American patients with type 2 diabetes received point-of-care education, coaching, and medication intensification from a diabetes care management team made up of a pharmacist, nurse, and a dietitian. Those were matched with five randomly selected control practices with similar patient characteristics where African-American patients received usual care. The effects of the intervention were measured using intermediate (median 18 months) and long-term (median 36 months) changes in glycated hemoglobin (hemoglobin A1c) levels, blood pressure, and lipid levels, as well as the proportion of patients meeting target values. During the study, the care team traveled to the three different intervention practice sites on different days and provided proactive, individualized, office-based care management and follow-up as part of the usual office visit. Patients with new-onset type 2 diabetes mellitus or who had a hemoglobin A1c levels greater than 7.5% were also scheduled to be seen by one of the care managers. The clinical targets in the intervention practices included reducing elevated hemoglobin A1c levels to 7.5%, blood pressure to less than 140/90 mm Hg, and low-density lipoprotein (LDL) cholesterol levels to less than 100 mg/dL. While the targets may appear higher than the ideal, study authors said they were selected “because many of these patients were older, had multiple comorbidities, and had a long duration of diabetes, and because data have shown that African American patients have higher hemoglobin A1c values than white populations.” The 368 intervention patients had a significantly greater reduction in mean hemoglobin A1c levels at intermediate (–0.5 % versus –0.2%) and long-term (–0.5% versus –0.10%) follow-up than the 359 control patients. In addition, the proportion of patients achieving a hemoglobin A1c level of less than 7.5% (68% vs. 59%) and/or a systolic blood pressure of less than 140 mm Hg (69% vs. 57%) was also significantly greater in the intervention practices than the control groups. “Our strategy suggests that a portion of chronic diabetes management can be accomplished with an inter-professional team, potentially making the clinicians more available for acute problems,” the authors write. “Our findings should be viewed as early evidence suggesting the effectiveness of an inter-professional environment similar to a patient-centered medical home.” |
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