Impact of pharmacy services on initial clinical outcomes and medication adherence among veterans with uncontrolled diabetes

• Published in: BMC health services research 2018-11, Vol.18 (1), p.855-855, Article 855
• Main Authors: Gatwood, Justin D, Chisholm-Burns, Marie, Davis, Robert, Thomas, Fridtjof, Potukuchi, Praveen, Hung, Adriana, Shawn McFarland, M, Kovesdy, Csaba P
• Format: Article
• Language: English
• Subjects: Accountable care organizations; Adherence; Aged; Ambulatory care; Antidiabetics; Antihypertensives; Blood pressure; Care and treatment; Clinical outcomes; Collaboration; Cost analysis; Data warehouses; Decision support systems; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - drug therapy; Disease management; Drug stores; Drug therapy; Electronic health records; Epidemiologic Methods; Female; Generalized linear models; Glycated Hemoglobin A - metabolism; Health care access; Health maintenance organizations; Health services; Hemoglobin; HMOs; Humans; Hypoglycemic Agents - therapeutic use; Influence; Lipids; Male; Medication Adherence; Mental health; Middle Aged; Patient compliance; Patients; Pharmacists; Pharmacists - organization & administration; Pharmacists - statistics & numerical data; Pharmacy Service, Hospital - organization & administration; Pharmacy Service, Hospital - statistics & numerical data; Pharmacy services; Primary care; Primary Health Care - statistics & numerical data; Professional-Patient Relations; Services; Social aspects; Teams; United States; United States Department of Veterans Affairs; Veterans; Veterans - statistics & numerical data
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3665-x

Diabetes remains a growing public health threat but evidence supports the role that pharmacists can play in improving diabetes medication use and outcomes. To improve the quality of care, the Veterans Health Administration has widely adopted care models that integrate clinical pharmacists, but more data are needed to interpret the impact of these services. Our objective was to assess clinical pharmacy services' impact on outcomes and oral antidiabetic medication (OAD) use among veterans with uncontrolled diabetes in the first year of therapy. This was a retrospective cohort analysis using the Veterans Affairs (VA) Corporate Data Warehouse to identify the first diagnosis of and initiation of OAD therapy for uncomplicated, uncontrolled diabetes (A1C > 7.0%) during 2002-2014. Receipt of clinical pharmacy services was identified using codes within VA electronic health records, and clinical values were obtained at or near the initial fill date and 365 days later. Use of OADs was assessed by proportion of days covered (PDC) for one year following the first filled prescription. Veterans having received clinical pharmacy services were matched 1:1 to those having not seen a clinical pharmacist in the first year of therapy, and generalized linear models assessed changes and differences in outcomes. The analysis included 5749 patients in each cohort. On average, patients saw a clinical pharmacist 2.5 times throughout the first year of OAD therapy. Adherence to OAD medications was higher in veterans having seen a pharmacist (84.3% vs. 82.4%, p