Stockton Katharine, Deas Crystal
Samford University, McWhorter School of Pharmacy.
Innov Pharm. 2019 Aug 31;10(2). doi: 10.24926/iip.v10i2.1737. eCollection 2019.
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.
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.
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).
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.
糖尿病会给患者带来重大疾病负担，在医疗服务不足、就医机会有限的患者群体中，糖尿病管理往往具有挑战性。开展了一项试点研究，以确定通过电话提供的药剂师主导的胰岛素滴定服务对当地门诊护理诊所中大量医疗服务不足患者群体的影响。该试点服务于2018年春季在库珀·格林慈善医疗服务中心（CGMHS）实施，由一名附属临床药剂师提供，该药剂师也是桑福德大学麦克沃特药学院的教员。在CGMHS糖尿病诊所接受治疗的患者有资格被转介到该服务。该服务通过合作医疗协议提供。本研究的目的是评估和比较接受远程药学服务的患者与标准治疗的临床结果。标准治疗定义为胰岛素治疗仅由初级保健提供者或糖尿病诊所提供者管理，临床药剂师不参与患者护理的患者。
本手稿展示了在CGMHS对19岁及以上、有1型或2型糖尿病确诊记录、在2018年2月至2018年9月（试点远程药学服务的最初几个月）期间接受治疗的患者进行回顾性病历审查的结果。
67名患者符合纳入分析的标准——16名接受远程药学服务管理，28名在糖尿病诊所管理，23名在初级保健管理。远程药学组患者的平均糖化血红蛋白（A1c）变化为-1.14%，而糖尿病诊所组为-0.88%，初级保健组为+0.21%（p = 0.061）。在远程药学组中，43.75%的患者A1c从基线至少降低了1%，而糖尿病诊所组为35.71%，初级保健组为26.09%（p = 0.51）。
胰岛素滴定临床药学服务的整合对患者的血糖控制程度产生了积极影响。尽管本研究未观察到A1c有统计学意义的降低，但应注意到药剂师干预与从基线降低A1c的百分比略高于标准治疗相关。药剂师主导的服务在临床结果上产生的变化在数值上超过了在糖尿病诊所和初级保健中接受专科护理的患者所经历的变化。由于这项研究，试点项目仍然有效，并且正处于将咨询服务扩展到符合条件的初级保健患者的初始阶段。
