Wagner Tyler D, Dixon Dave L, Shin Yongyun, Dozmorov Mikhail, Musselman Kerri T, Buffington Tonya M, Hyder Haroon, Kirschner Bryan, Jones Resa M, Salgado Teresa M
Center for Pharmacy Practice Innovation, Virginia Commonwealth University School of Pharmacy, Richmond.
Department of Pharmaco-therapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond.
J Manag Care Spec Pharm. 2025 Jun;31(6):565-577. doi: 10.18553/jmcp.2025.31.6.565.
Multidisciplinary primary care models incorporating pharmacists have emerged to improve glycemic control in patients with uncontrolled type 2 diabetes mellitus (T2DM). Healthcare Effectiveness Data and Information Set (HEDIS) measures establish quality benchmarks for comprehensive diabetes care and guide reimbursement. Large-scale research on the effect of pharmacist interventions to improve these quality measures in primary care remains limited.
To evaluate the effectiveness of a pharmacist-physician collaborative care (PPCC) model on comprehensive diabetes care quality measure achievement compared with standard care (SC).
This retrospective cohort study included adults aged 18 to 75 years with uncontrolled T2DM receiving care in primary care clinics at a community-based health system in Virginia from July 1, 2018, to December 31, 2019. Patients were in one of 2 groups: (1) the intervention group (PPCC), where embedded pharmacists provided diabetes management under a collaborative practice agreement, and (2) the comparator group receiving SC in clinics without pharmacists. The SC group was created via 1:2 propensity score matching. Generalized linear mixed models assessed the association between group and quality measure achievement. Primary outcomes included glycated hemoglobin (hemoglobin A1c) (≤9%, ≤8%, ≤7%) and blood pressure control (<140/90 mm Hg), per the last recorded value in 2019.
The sample (N = 1,293) had a mean age of 57 years, was 56% female, and 45% each White and Black. The PPCC group (n = 431) was more likely to achieve A1c control compared with the SC group (n = 862) (A1c <9%: odds ratio [OR] = 3.68, 95% CI = 2.31-5.84; A1c <8%: OR = 3.53, 95% CI = 2.12-5.89; A1c <7%: OR = 4.61, 95% CI = 2.48-8.56; all < 0.01). Similarly, the PPCC group was more likely to achieve blood pressure control less than 140/90 mm Hg (OR = 1.49, 95% CI = 1.01-2.22; = 0.04).
Patients in the PPCC group were more likely to meet comprehensive diabetes care quality measures compared with SC. These results underscore the value of pharmacists in diabetes management in primary care and their contribution to value-based care.
包含药剂师的多学科初级保健模式已出现，以改善2型糖尿病（T2DM）控制不佳患者的血糖控制。医疗保健有效性数据和信息集（HEDIS）指标为全面糖尿病护理确立了质量基准并指导报销。关于药剂师干预对改善初级保健中这些质量指标效果的大规模研究仍然有限。
评估药剂师 - 医生协作护理（PPCC）模式与标准护理（SC）相比在实现全面糖尿病护理质量指标方面的有效性。
这项回顾性队列研究纳入了2018年7月1日至2019年12月31日在弗吉尼亚州一个社区卫生系统的初级保健诊所接受治疗的18至75岁T2DM控制不佳的成年人。患者分为两组之一：（1）干预组（PPCC），其中嵌入式药剂师根据协作实践协议提供糖尿病管理；（2）在没有药剂师的诊所接受SC的对照组。通过1:2倾向评分匹配创建SC组。广义线性混合模型评估组与质量指标达成之间的关联。主要结局包括糖化血红蛋白（血红蛋白A1c）（≤9%，≤8%，≤7%）和血压控制（<140/90 mmHg），依据2019年最后记录值。
样本（N = 1293）的平均年龄为57岁，56%为女性，白人和黑人各占45%。与SC组（n = 862）相比，PPCC组（n = 431）更有可能实现A1c控制（A1c <9%：优势比[OR] = 3.68，95%置信区间[CI] = 2.31 - 5.84；A1c <8%：OR = 3.53，95% CI = 2.12 - 5.89；A1c <7%：OR = 4.61，95% CI = 2.48 - 8.56；均P < 0.01）。同样，PPCC组更有可能实现血压控制低于140/90 mmHg（OR = 1.49，95% CI = 1.01 - 2.22；P = 0.04）。
与SC相比，PPCC组患者更有可能达到全面糖尿病护理质量指标。这些结果强调了药剂师在初级保健糖尿病管理中的价值及其对基于价值的护理的贡献。
