Evaluation of Outcomes of a Pharmacist-Run, Outpatient Insulin Titration Telepharmacy Service
Purpose: Diabetes can pose a significant disease burden for patients and is often challenging to manage in underserved patient populations with limited access to care. A pilot study was conducted to determine the impact of a pharmacist-run insulin titration service, provided via telephone, to patients of a local ambulatory care clinic with a large medically, underserved patient population. The pilot service was implemented in Spring 2018 at Cooper Green Mercy Health Services (CGMHS) and was provided by an affiliate clinical pharmacist who is also on faculty at Samford University’s McWhorter School of Pharmacy. Patients who received care within the CGMHS diabetes clinic were eligible for referral to the service. The service was provided via a collaborative practice agreement. The purpose of this study was to evaluate and compare clinical outcomes of patients who received the telepharmacy service versus the standard of care. Standard of care was defined as patients whose insulin therapy was managed solely by the primary care provider or by a diabetes clinic provider, without clinical pharmacist involvement in the patient’s care.
Methods: This manuscript presents the results of a retrospective chart review conducted at CGMHS of patients, ages 19 or older, with a documented diagnosis of type 1 or type 2 diabetes who received care during the timeframe of February 2018 through September 2018 – the initial months of the pilot telepharmacy service.
Results: Sixty-seven patients met criteria for inclusion in the analysis - 16 managed in the telepharmacy service, 28 in diabetes clinic, and 23 in primary care. Patients in the telepharmacy group achieved a mean A1c change of -1.14% compared with -0.88% in the diabetes clinic group and +0.21% in the primary care group (p=0.061). In the telepharmacy group, 43.75% of patients experienced at least a 1% reduction in A1c from baseline compared with 35.71% in the diabetes clinic group and 26.09% in primary care (p=0.51).
Conclusion: Integration of the clinical pharmacy services for insulin titration positively affected patients’ degree of glucose control. Although no statistically significant reductions in A1c were observed in this study, it should be noted that pharmacist intervention was associated with a modestly higher percent A1c reduction from baseline vs. the standard of care. The pharmacist-run service produced changes in clinical outcomes that numerically exceeded those experienced by patients receiving specialty care, in the diabetes clinic, and within primary care. As a result of this study, the pilot program has remained in effect and is in the initial stages of expansion of the consult service to eligible primary care patients.
Article Type: Original Research
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