Ambulatory Care Pharmacists Help Decrease A1c Levels in Primary Care Program | ADA 2025
The initiative focuses on managing medications for high-risk diabetes patients through a collaborative drug therapy agreement.
In a service sponsored by Washington State University and conducted at a Rockwood Clinic in Spokane, Washington, Nathan Ramsbacher, PharmD, clinical assistant professor of pharmacotherapy at Washington State University, discusses the impact of an ambulatory care pharmacist on clinical and quality outcomes in primary care. Launched in June 2023, the initiative focused on managing medications for high-risk diabetes patients through a collaborative drug therapy agreement.
The pharmacist-led service targeted patients with A1c levels above 9%, recent diabetes-related hospitalizations, or histories of severe hypoglycemia. By providing frequent visits—sometimes weekly—the pharmacists could offer comprehensive care beyond traditional provider schedules. Their approach integrated medication management, diabetes education, lifestyle counseling, and assistance with medication access and affordability. The results showed reductions in the number of patients with A1c levels above 9% by 89, with an average A1c reduction of 1.56%. This success stemmed from reducing clinical inertia, increasing care visit accessibility, and ensuring patients could afford and adhere to their prescribed medications. The pharmacists also worked to improve several clinical quality metrics.
Key improvements included increasing eye exam referrals for diabetes patients, enhancing statin adherence by addressing patient concerns and demonstrating cardiovascular risk reduction, and improving kidney health monitoring through comprehensive yearly exams. The pharmacists went beyond traditional medical interactions by educating patients about the importance of these health measures and helping them understand their personal health risks, according to Ramsbacher.
Leveraging Washington State's progressive pharmacist scope, which allows direct billing to Medicaid and commercial insurances, the program demonstrated the potential of integrating clinical pharmacists into primary care settings. The multifaceted approach not only improved clinical outcomes but also empowered patients to manage their diabetes more effectively, ultimately supporting their goal of living longer, healthier lives.
"These are all essential parts of the American Diabetes Association, standards of care, and the national guidelines that promote the absolute peak quality of health care for people with diabetes," Ramsbacher said. "[We try] to educate patients on why these are important for their health, ensuring that they live not only long lives but good quality lives."
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