Schwenka Natalie, Donovan Anthony, Franck Logan, Coan Canice, McAdam-Marx Carrie, Shin Emily
J Am Pharm Assoc (2003). 2023 Sep-Oct;63(5):1545-1552.e4. doi: 10.1016/j.japh.2023.06.004. Epub 2023 Jun 8.
Patients with uncontrolled diabetes are at risk for developing complications. Many health care systems have implemented multidisciplinary care models including pharmacists to help achieve quality care measures to reduce complications.
This study aimed to evaluate whether patients with uncontrolled type 2 diabetes mellitus (T2D) seen at patient-centered medical home (PCMH) clinics affiliated with an academic medical center are more likely to meet a composite of diabetes quality care measures with a pharmacist on their care team than usual care patients without a pharmacist on their care team.
This is a cross-sectional study. The setting included PCMH primary care clinics affiliated with an academic medical center from January 2017 to December 2020. Included were adults aged 18 to 75 years with a diagnosis of T2D, hemoglobin A1C (A1C) more than 9%, and established with a PCMH provider. The intervention is inclusion of PCMH pharmacist on the patient's care team for management of T2D per a collaborative practice agreement. The main outcome measures included A1C ≤9% per last recorded value during observation period, a composite A1C ≤9% and completion of yearly laboratory tests, and a composite A1C ≤9%, completion of yearly laboratory tests, and statin prescription for adults aged 40-75 years.
Identified were 1807 patients in the usual care cohort with mean baseline A1C of 10.7% and 207 patients in the pharmacist cohort with mean baseline A1C of 11.1%. The pharmacist cohort was more likely to have an A1C of ≤9% at the end of the observation period (70.1% vs. 45.4%; P < 0.001), a composite of measures met (28.5% vs. 16.8%; P < 0.001), and a composite of measures met for patients aged 40-75 years (27.2% vs. 13.7%; P < 0.001).
Pharmacist involvement in the multidisciplinary management of uncontrolled T2D is associated with a higher attainment of a composite of quality care measures at the population health level.
糖尿病控制不佳的患者有发生并发症的风险。许多医疗保健系统已实施多学科护理模式，包括药剂师，以帮助实现优质护理措施，减少并发症。
本研究旨在评估在与学术医疗中心相关的以患者为中心的医疗之家（PCMH）诊所就诊的2型糖尿病（T2D）控制不佳的患者，与护理团队中没有药剂师的常规护理患者相比，护理团队中有药剂师的患者是否更有可能达到糖尿病优质护理措施的综合目标。
这是一项横断面研究。研究背景包括2017年1月至2020年12月与学术医疗中心相关的PCMH初级保健诊所。纳入的患者为年龄在18至75岁之间、诊断为T2D、糖化血红蛋白（A1C）超过9%且已在PCMH机构就诊的成年人。干预措施是根据合作实践协议，将PCMH药剂师纳入患者护理团队以管理T2D。主要结局指标包括观察期内最后记录值的A1C≤9%、A1C≤9%且完成年度实验室检查的综合指标，以及40 - 75岁成年人的A1C≤9%、完成年度实验室检查且开具他汀类药物处方的综合指标。
在常规护理队列中确定了1807名患者，平均基线A1C为10.7%，在药剂师队列中有207名患者，平均基线A1C为11.1%。药剂师队列在观察期结束时更有可能A1C≤9%（70.1%对45.4%；P < 0.001）、达到综合指标（28.5%对16.8%；P < 0.001），以及40 - 75岁患者达到综合指标（27.2%对13.7%；P < 0.001）。
药剂师参与未控制的T2D的多学科管理与在人群健康层面更高程度地达到优质护理措施综合目标相关。
