Correctional Health Services, 140483Los Angeles County Department of Health Services, Angeles, CA, USA.
J Pharm Pract. 2021 Aug;34(4):596-599. doi: 10.1177/0897190019888075. Epub 2019 Nov 19.
Incarcerated patients often have a high disease burden and poor access to care in the community. In an effort to ensure glycemic control and appropriate initiation of statin therapy for cardiovascular (CV) risk reduction, a pilot program of pharmacist-led diabetes clinic (PLDC) was implemented in a large inner-city jail. A pre-post study was conducted as a quality improvement initiative. Inclusion criteria were inmate-patients (IPs) diagnosed with type 2 diabetes mellitus, treated with oral antidiabetic medications, managed by PLDC, and with at least 2 glycosylated hemoglobin As (HbA). The primary outcome was the change in HbA after PLDC. The secondary outcome was the frequency of statin therapy. A total of 240 IPs met the inclusion criteria. Mean HbA was 8.2% at baseline and 7.6% at the last follow-up encounter, a change of -0.7% (95% confidence interval [CI]: -0.41% to -0.93%). The most dramatic change was seen in the group with the highest initial HbA (HbA ≥ 10%), from a mean baseline HbA of 11.6% to 8.5%, a change of -3.1% (95% CI: -2.5% to -3.7%). IPs with an initial HbA between 7% and 9.9% showed a change in mean HbA from 8.4% to 8.0%, a change of -0.4% (95% CI: -0.1% to -0.7%). Of the 240 included IPs, 141 were not on a statin at baseline. The frequency of statin use increased by 50.4% after PLDC. PLDC significantly improved glycemic control and guideline concordance for CV risk reduction. Adding PLDC to multidisciplinary care teams has the potential to improve population health outcomes for this medically complex, yet underserved patient population.
在押患者通常疾病负担高，在社区获得医疗服务的机会有限。为了确保血糖控制和适当启动他汀类药物治疗以降低心血管 (CV) 风险，在内城大型监狱中实施了一项由药剂师主导的糖尿病诊所 (PLDC) 试点计划。该计划作为一项质量改进倡议进行了一项前后研究。纳入标准为患有 2 型糖尿病、接受口服抗糖尿病药物治疗、由 PLDC 管理且至少有 2 次糖化血红蛋白 A (HbA) 的囚犯患者 (IPs)。主要结果是 PLDC 后 HbA 的变化。次要结果是他汀类药物治疗的频率。共有 240 名 IP 符合纳入标准。基线时的平均 HbA 为 8.2%，最后一次随访时为 7.6%，变化为-0.7% (95%置信区间 [CI]：-0.41%至-0.93%)。变化最明显的是初始 HbA 最高的组 (HbA≥10%)，从基线平均 HbA 11.6%降至 8.5%，变化为-3.1% (95% CI：-2.5%至-3.7%)。初始 HbA 在 7%至 9.9%之间的 IPs，平均 HbA 从 8.4%降至 8.0%，变化为-0.4% (95% CI：-0.1%至-0.7%)。在 240 名纳入的 IPs 中，有 141 名在基线时未服用他汀类药物。PLDC 后他汀类药物的使用频率增加了 50.4%。PLDC 显著改善了血糖控制和降低 CV 风险的指南一致性。将 PLDC 添加到多学科护理团队中有可能改善这一医疗复杂但服务不足的患者群体的人群健康结果。
