Moreau Cynthia, Sando Karen R, Zambrano Daniel H
1 Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA.
2 University of Florida College of Pharmacy, Gainesville, FL, USA.
Ann Pharmacother. 2017 Jun;51(6):473-478. doi: 10.1177/1060028016685731. Epub 2017 Jan 7.
The care of diabetic patients in rural areas is complicated by factors such as poor health literacy, cultural barriers, and primary care provider (PCP) shortages. Integrating pharmacist care in diabetes management in these settings may increase access to care and improve patient outcomes.
To evaluate differences in diabetes-related outcomes in patients with type 2 diabetes (T2DM) managed by a pharmacist diabetes clinic compared with patients only managed by PCPs in a rural family medicine clinic.
This was a retrospective case-control study. The primary outcome was achievement of hemoglobin A (A1C) reduction ≥0.5%. Secondary outcomes included average A1C reduction, achievement of A1C goal, angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) use, statin use, blood pressure control, and frequency of nephropathy screenings. Patients ≥18 years old with an A1C ≥7% were eligible. Cases included patients established with the pharmacist diabetes clinic. Cases were matched to controls in a 1:1 ratio based on PCP, age (±5 years), gender, and race.
A total of 21 pharmacist-managed patients met inclusion criteria. Cases were significantly more likely to experience an A1C reduction ≥0.5% (odds ratio = 7.51; 95% CI = 1.54-36.61; P < 0.01). Statistically significant improvements were also noted for ACE inhibitor/ARB use, statin use, and nephropathy screenings among cases.
Patients managed by a pharmacist diabetes clinic were more likely to experience improved diabetes-related outcomes, including A1C reduction ≥0.5%. Pharmacist care, when added to standard care, can improve outcomes for patients with T2DM in rural areas.
农村地区糖尿病患者的护理因健康素养低、文化障碍和初级保健提供者（PCP）短缺等因素而变得复杂。在这些环境中将药剂师护理纳入糖尿病管理可能会增加获得护理的机会并改善患者预后。
评估由药剂师糖尿病诊所管理的2型糖尿病（T2DM）患者与仅由农村家庭医学诊所的PCP管理的患者在糖尿病相关结局方面的差异。
这是一项回顾性病例对照研究。主要结局是血红蛋白A（A1C）降低≥0.5%。次要结局包括平均A1C降低、达到A1C目标、使用血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）、使用他汀类药物、血压控制和肾病筛查频率。年龄≥18岁且A1C≥7%的患者符合条件。病例包括在药剂师糖尿病诊所就诊的患者。根据PCP、年龄（±5岁）、性别和种族，病例与对照按1:1的比例匹配。
共有21名由药剂师管理的患者符合纳入标准。病例组更有可能经历A1C降低≥0.5%（优势比 = 7.51；95%置信区间 = 1.54 - 36.61；P < 0.01）。病例组在ACE抑制剂/ARB使用、他汀类药物使用和肾病筛查方面也有统计学上的显著改善。
由药剂师糖尿病诊所管理的患者更有可能在糖尿病相关结局方面得到改善，包括A1C降低≥0.5%。在标准护理基础上增加药剂师护理可以改善农村地区T2DM患者的结局。
