Department of Pharmacy Practice, Texas A&M Irma Lerma Rangel College of Pharmacy, Kingsville, TX, USA.
Department of Pharmacotherapeutics and Clinical Research, University of South Florida Taneja College of Pharmacy, Tampa, FL, USA.
J Pharm Pract. 2023 Dec;36(6):1392-1396. doi: 10.1177/08971900221118232. Epub 2022 Aug 7.
Chronic care management (CCM) can significantly impact the management of chronic diseases in rural patient populations. To date, few practice models have addressed its impact on clinical outcomes and access to care in rural practice settings. Implement a sustainable pharmacist-led CCM practice model while tracking clinical outcomes and healthcare access at a rural, medically underserved family medicine clinic. This study retrospectively examined data from the clinic's CCM program from October 2020 through May 2021 and included total clinical encounters at three- and 6-months intervals, as well as changes in clinical outcomes like A1c and systolic blood pressure (SBP) at three- and 6-months intervals. Over an 8-month period, 46 patients were enrolled in pharmacist-led CCM services. Those with a CCM encounter or office visit within 3 months of enrollment showed a mean A1c reduction of 1.07% after 3 months (95% CI -1.70 to -.44, = .0016), while those with an encounter or office visit within 6 months of enrollment displayed a mean A1c reduction of 1.64% after 6 months (95% CI -2.35 to -.92, < .001). There was a 73.8% increase in total clinical encounters in the 6 months after CCM enrollment compared to the 6 months preceding it, signifying increased access to care. Patients with CCM encounters or office visits within the first 3-6 months experienced statistically significant reductions in A1c. Moreover, total clinical encounters markedly increased in the 6 months after enrollment, allowing for more frequent engagement between ambulatory pharmacists and traditionally challenging rural patients.
慢性疾病管理（CCM）可以显著影响农村患者群体的慢性病管理。迄今为止，很少有实践模式解决其对农村实践环境中临床结果和获得医疗服务的影响。在一家农村医疗服务不足的家庭医学诊所，实施可持续的药剂师主导的 CCM 实践模式，同时跟踪临床结果和医疗服务的获取情况。本研究回顾性分析了该诊所 CCM 项目从 2020 年 10 月到 2021 年 5 月的数据，包括在 3 个月和 6 个月间隔的总临床就诊次数，以及在 3 个月和 6 个月间隔的 A1c 和收缩压（SBP）等临床结果的变化。在 8 个月的时间里，有 46 名患者参加了药剂师主导的 CCM 服务。在入组后 3 个月内有 CCM 就诊或就诊的患者，3 个月后 A1c 平均降低 1.07%（95%置信区间-1.70 至-.44，.0016），而在入组后 6 个月内有 CCM 就诊或就诊的患者，6 个月后 A1c 平均降低 1.64%（95%置信区间-2.35 至-.92， <.001）。与入组前的 6 个月相比，入组后 6 个月的总临床就诊次数增加了 73.8%，表明获得医疗服务的机会增加。在入组后前 3-6 个月内有 CCM 就诊或就诊的患者 A1c 显著降低。此外，入组后 6 个月的总临床就诊次数显著增加，使流动药剂师与传统上具有挑战性的农村患者之间有更多的互动机会。
