Medication management help HMO diabetes patients

Pharmacist recommendations shared with physicians

When pharmacists run diabetes management programs for HMO patients, the patients have better health outcomes than patients who are only monitored for long-term blood sugar control. That's the takeaway from a nine-month study that evaluated the effect of such pharmacist-run diabetes management programs.

Principal investigator Lourdes Planas, PhD, an assistant professor at the University of Oklahoma, College of Pharmacy, tells Drug Formulary Review the findings "help support the increasing role of proactive pharmacists. Pharmacists are proactively teaching patients to control their diabetes when they provide medication therapy management. They are teaching them about healthy eating habits and self-monitoring of blood sugar levels so they can be empowered to take care of their diabetes."

The study was funded by a grant from the ASHP Foundation. Planas presented it during the 2007 American Society of Health-system Pharmacists' midyear clinical meeting in December.

The research came about, Planas tells Drug Formulary Review, because her co-investigator, Kimberly Crosby, PharmD, wanted to find a way to document and evaluate medication therapy management with an eye to developing ways to formalize the practice so more health system patients could benefit from it. With the grant funding they received, they worked to set up a true experimental design through the Community Care HMO and pharmacists at the May Drug Stores.

Sixty-five participants enrolled in the study, with 38 in the intervention group receiving monthly medication therapy management services and 27 in the control group that received A1c monitoring every three months. All the patients entered the study with a hemoglobin A1c greater than 7.0%.

Changes in A1c levels and percentage of patients at goal A1c (less than 7%) were compared between the intervention and control groups after nine months of study participation. The incidence of drug therapy problems among intervention group participants also was reported.

Results from the 43 patients who completed the study included:

  • Change in A1c was significantly greater in the intervention group than in the control group: mean A1c level of 7.65 in the intervention group at baseline and 6.95 at nine months, compared with control group levels of 7.74 at baseline and 7.98 at nine months.
  • Change in percent of patients at goal A1c (less than 7.0%) was significantly greater in the intervention group than in the control group: 33% of participants in the intervention group were at goal at baseline and 58% at nine months, while the control group reported 16% were at goal at baseline and 11% at nine months.

Various services included

Medication therapy management services included diabetes education (the nature of the illness, how to manage it, how to use a glucose monitor, and dietary considerations); drug therapy assessment, checking patients' blood glucose monitors, and foot care. Recommendations were forwarded to the patients' doctors.

Planas says that while the intervention group had monthly visits with the pharmacists, they probably didn't need to be seen that often. "Based on patient severity, they wouldn't need to be seen every month," she says. "We found it was difficult for people to make and keep appointments each month."

Both Community Care and the May drugstore chain were pleased with the study results, Planas says, and there is hope the HMO will carve out some payment for such services.

Of interest to other health plans considering implementing such a program, while preliminary cost-savings analyses were not statistically significant, the raw data show cost-savings as a result of the program. In the intervention group, Planas tells DFR, costs decreased $2,180 over the nine-month period, while in the control group costs increased $3,664. Costs for prescription drugs increased in both groups; for the intervention group they went up $241 and for the control group $369.

[Editor's note: For more information c ontact Dr. Planas at (405) 271-6878, ext. 47294.]