From the Ascension Medical Group Via Christi, P.A., Wichita, KS
From the Ascension Medical Group Via Christi, P.A., Wichita, KS.
J Am Board Fam Med. 2020 Sep-Oct;33(5):745-753. doi: 10.3122/jabfm.2020.05.200044.
To evaluate the impact of physician-pharmacist collaboration for disease-state management on diabetes outcomes in primary care by comparing outcomes between physician-managed care and pharmacist collaborative care.
A retrospective, observational cohort study was conducted at Ascension Medical Group Via Christi, P.A. from January 1, 2016 to June 30, 2018. Health outcomes were analyzed in 385 patients with diabetes mellitus collaboratively managed by a physician and pharmacist (collaborative care group). Similar patients managed by physician only (usual care group) were matched to the collaborative care group using nearest neighbor matching. The primary outcome compared glycosylated hemoglobin (HbA1c) change between collaborative care and usual care groups at 12 months.
The mean change in HbA1c decreased by 1.75% in the collaborative care group and 0.16% in the usual care group ( < .0001). The usual care group had a larger number of patients with HbA1c less than 8% at follow-up ( = .0049). Additional outcomes included decrease in total cholesterol ( = .0023), triglycerides ( = .0016), and an increase in PPSV23 pneumococcal vaccinations ( = .0255) in the collaborative care group. The usual care group had an increase in PCV13 pneumococcal vaccinations ( = .0075). Both emergency department visits ( = .0162) and hospitalizations ( = .0225) decreased significantly in the collaborative care group, estimating total savings of $633,015.
The collaboration of pharmacists and physicians in the primary care setting is associated with improved diabetes outcomes and substantially reduces costs related to decreased health care use.
通过比较医生管理护理和药剂师合作护理的结果，评估疾病状态管理中医生-药剂师合作对初级保健中糖尿病结局的影响。
这是一项回顾性观察队列研究，于 2016 年 1 月 1 日至 2018 年 6 月 30 日在 Ascension Medical Group Via Christi，PA 进行。对由医生和药剂师共同管理的 385 例糖尿病患者（合作护理组）的健康结果进行分析。使用最近邻匹配，将与合作护理组相似的仅由医生管理的患者（常规护理组）与合作护理组进行匹配。主要结局比较合作护理组和常规护理组在 12 个月时糖化血红蛋白（HbA1c）的变化。
合作护理组的 HbA1c 平均变化降低了 1.75%，而常规护理组降低了 0.16%（<.0001）。常规护理组在随访时 HbA1c 小于 8%的患者数量更多（=.0049）。其他结果包括合作护理组总胆固醇（=.0023）、甘油三酯（=.0016）下降，以及 23 价肺炎球菌多糖疫苗（PPSV23）接种增加（=.0255）。常规护理组 13 价肺炎球菌多糖疫苗（PCV13）接种增加（=.0075）。合作护理组急诊就诊（=.0162）和住院治疗（=.0225）均显著减少，估计节省总费用为 633015 美元。
在初级保健环境中，药剂师和医生的合作与改善糖尿病结局相关，并显著降低与医疗保健使用减少相关的成本。
