Better T2DM glycemic control achieved when pharmacists and physicians collaborated

May 15, 2013

Collaboration produced better outcomes without use of additional meds

Pharmacists working in a collaborative relationship with physicians in different practice settings were able to help more patients with type 2 diabetes achieve glycemic control without adding to the medication burden, according to a report published May 8 in The Annals of Pharmacotherapy.

Michelle Z. Farland, PharmD, BCPS, of the College of Pharmacy, Health Science Center, University of Tennessee, Knoxville, and her colleagues enrolled more than 200 patients with type 2 diabetes from seven practice sites in Tennessee for the 12-month study. The majority of the patients were male (60%) and white (66%), with a mean age of 60 years.

Before the prospective multicenter study started, the collaborative teams of pharmacists and physicians were developed. "The methods for collaboration could include (1) a practice agreement that permitted pharmacists the authority to independently prescribe medication therapy for patients with diabetes, (2) pharmacist-physician patient appointments in which both professionals would evaluate the patient and develop a treatment plan at the point of care, and (3) pharmacist patient appointments in which the pharmacist would discuss each case with the physician to develop a treatment plan at the point of care," Farland and her colleagues wrote.

Patients were followed for 1 year with visits occurring at 1- to 12-week intervals or as needed. Pharmacist services included patient education, reviews of self-monitored blood glucose logs, reviews of laboratory data, foot examinations, recommendations for immunizations, and referrals for dilated retinal examinations. In addition, pharmacists provided medication therapy management of antihyperglycemic, antihypertensive, or lipid-lowering drugs. Barriers to achievement of diabetes treatment goals were ascertained from patients and their physicians and recorded.

The study goals were to determine any improvement in hemoglobin A1c levels and the proportion of patients who achieved A1c levels less than 7%, the goal for glycemic control established by the American Diabetes Association and the European Association for the Study of Diabetes. They also wanted to determine the percentage of patients with A1c levels greater than 9%.

At the end of the study, the A1c levels declined by an average of 1.16% (P <.0001), from a mean baseline A1c of 8.90%. More than one-third of the patients achieved A1c levels less than 7%, compared to about 13% at baseline (P=.0002). In addition, only 16.5% of patients had A1c levels greater than 9% at the study’s end, compared with 34% at baseline (P <.0001).

"We attribute the observed A1c reduction to the combination of services provided, such as optimizing medications, providing patient education, and identifying barriers to achieving glycemic control," the authors explained.

“Pharmacist-physician collaborative management at multiple practice locations and types of setting (e.g., private, academic, Veterans Affairs medical center) has a positive impact on glycemic control and diabetes-related health maintenance,” the authors concluded. “This was accomplished without increasing the total number of antihyperglycemic agents prescribed and without an increase in patient-reported episodes of hypoglycemia.”