Impact of clinical pharmacy specialists on glycemic control in veterans with type 2 diabetes.

PURPOSE

The results of a study to determine the impact that Patient Aligned Care Team clinical pharmacy specialists (CPSs) have in improving glycemic control among veterans with type 2 diabetes are reported.

METHODS

Reductions in glycosylated hemoglobin (HbA1c) values in diabetic patients are associated with improved outcomes related to vascular complications. Current diabetes management strategies at the Cincinnati Veteran Affairs Medical Center (VAMC) involve a multidisciplinary approach that includes visits with a CPS by veterans referred by a primary care provider. A retrospective chart review-based study of veterans who received CPS care for diabetes management was conducted. The primary outcome was HbA1c reduction after up to 18 months of CPS care; subgroup analyses by type of clinic visit (face-to-face versus telephone), age group, Care Assessment Need (CAN) Score, and number of visits within an 18-month time frame were performed.

RESULTS

There was a 2.2% absolute reduction in the mean HbA1c value among veterans receiving CPS care for up to 18 months. There was no statistically significant difference in absolute HbA1c reduction by type of clinic visit. The greatest absolute HbA1c reduction was observed in the following subgroups: 60- to 69-year-old veterans, veterans with a CAN score of ≥90, and veterans who had 5 or more CPS visits.

CONCLUSION

CPSs at the Cincinnati VAMC significantly reduced the HbA1c of uncontrolled, complex diabetic veterans. The reduction in HbA1c was greatest in patients who had more than 5 encounters with a CPS over the 18-month data collection period.