2017 Resarch Forum

PHARM: M-2

Applicant & Principal Investigator: Elliott Asarch PharmD

Quality outcomes of a pharmacist-led safety-net diabetes clinic Elliott Asarch PharmD, Jeff Jolliff PharmD

INTRODUCTION The Public Hospital Redesign and Incentives in Medi-Cal (PRIME) initiative is a pay-for-performance incentive program for California public health care systems. One performance measure established by this program provides health systems financial incentive to improve diabetes care in their patient population (measured by proportion of diabetic patients with hemoglobin A1c (A1c) above 9%). Previous studies of pharmacist managed safety-net clinics have demonstrated that these clinics provide quality and cost-effective care; however, data is lacking to compare outcomes of these clinics to the PRIME initiative targets. PURPOSE To compare the clinical outcomes of a pharmacist-led diabetes clinic to PRIME goals in order to ensure the clinic is meeting quality performance standards. METHOD The study evaluated 100 patients diagnosed with type 2 diabetes mellitus who received care from the pharmacist-led diabetes clinic for a minimum of two visits, at least three months apart from November 2011 to June 2016. Patients were included in the study if they had poor blood sugar control resulting in a A1c level greater than or equal to seven percent and were between the ages of 18 and 75. Patients were excluded from the study if they had documented non-compliance, if they were lost to follow up, or if they did not have appropriate labs drawn at baseline and after 3 months of treatment. The study evaluated the mean change in A1c and compared the proportion of patients that met various PRIME goals at baseline compared to the proportion of patients that met goals after pharmacist diabetes clinic intervention. Chi square, Fisher’s exact, and Student’s t tests were utilized for data analysis as appropriate. RESULTS PRIME goal of Hemoglobin A1c < 9% was met for 60 out of the 73 patients (82.2%) who followed up at 3-6 months, compared to only 23 of the 73 patients (31.5%) who met the PRIME goal at baseline (p<0.0001). Patients had overall mean A1c reduction of 2.56% (95% CI 1.99% - 3.12 %). Of the patients who were followed for 24 months, 25 of 30 (83.3%) maintained glycemic control at the PRIME goal A1c of <9%. DISCUSSION/CONCLUSION This pharmacist-led diabetes clinic showed significant improvements in the glycemic control of patients who were referred to this service and significantly increased the likelihood of patients’ reaching goal A1c for the PRIME quality metric. The results demonstrate long term glycemic control in patients who continued to follow up in clinic (24 months).