1. * Indicates p < 0.05 indicates p < 0.05 Evaluating Clinical Pharmacist Impact on Diabetes Control* Mary Ella Hill, Pharm. D. Candidate; Orijane Dalton, Pharm. D. Candidate; Seth Hill, BS; Emily McCoy Armstrong, Pharm. D, BPACP Background  Pharmacists collaborating with patients with chronic medical conditions, such as Diabetes Mellitus, could improve reduce blood glucose levels and improve patient outcomes  2003- The Asheville Project: Pharmacist impact on Diabetes patients improved HbA1c and lipid levels by >50%, and decreased number in sick days, and direct patient costs 1,2,3  2008- Pharmacist-managed Diabetes Mellitus Under Collaborative Drug Therapy Agreement: Significantly reduced HbA1c, mean blood glucose, and patient costs 4  2008- Systematic review on Effects of Pharmacist Outpatient Interventions on Adults with Diabetes: Noted decreases in HbA1c, Blood pressure, LDL, and triglycerides in patients with Diabetes 5 Methods  Approved by the Institutional Review Board for University of South Alabama and Auburn University  Retrospective chart review  Patient population from internal medicine outpatient clinic  Data obtained by chart review and electronic medical records  Data collected was de-identified  Inclusion Criteria:  ICD-9 code for Type 2 Diabetes  Have had a valid patient-provider relationship with the clinical pharmacist at Knollwood Physicians group  Seen between January 1, 2010 and December 31, 2011  Exclusion Criteria:  Pregnant  Renal or hepatic disease  Age less than 19 Conclusions  Preliminary results suggest clinical pharmacists have most significant impact on HbA1c in first 3 to 6 months of treatment  Improvement in lipid values was statistically significant for triglycerides at 3 months and HDL at 9 months of treatment  This study illustrates that clinical pharmacists can have a positive impact on diabetes management  The limitation of the small sample size at 9 and 12 months may have contributed to non-significant values Interim Results & Analysis  262 charts identified  26 charts with results at this time  HbA1c lower than baseline at each follow up interval, with change reaching statistical significance at 3 months (p=0.036)  Statistically significant decrease in triglycerides (p=0.0229) and HDL improvement (p=0.038) also seen at 3 and 9 month mark, respectively  No significant improvements seen in blood pressure, total cholesterol, or LDL levels  8 (31%) patients converted to insulin therapy  Average number of diabetic medications increased from 1.5 to 2 medications per person StrengthsLimitations Inexpensive Data readily accessible Uses existing data Retrospective Relies on accuracy of written record One pharmacist at clinic Small sample size References 1. Cranor CW, Christensen DB. The Asheville Project: Factors Associated With Outcomes of Community Pharmacy Diabetes Care Program. Journal of the American Pharmaceutical Association [Internet]. 2003 March [cited 2012 November 6]; 43 (2):160-172. Available from: http://www.ncpharmacists.org/associations/4188/files/NCCPCthree.pdfhttp://www.ncpharmacists.org/associations/4188/files/NCCPCthree.pdf 2. Cranor CW, Christensen DB. The Asheville Project: Short-Term Outcomes of Community Pharmacy Diabetes Care Program. Journal of American Pharmaceutical Association [Internet]. 2003 March [cited 2012 November 6]; 43 (2):149-159. Available from: http://www.ncpharmacists.org/associations/4188/files/NCCPCtwo.pdfhttp://www.ncpharmacists.org/associations/4188/files/NCCPCtwo.pdf 3. Cranor CW, Bunting BA, Christensen DB. 3. The Asheville Project: Long-Term Clinical and Economic Outcomes of a Community Pharmacy Diabetes Care Program. Journal of American Pharmaceutical Association [Internet]. 2003 March [cited 2012 November 6]; 43 (2): 173-184. Available from: http://www.ncpharmacists.org/associations/4188/files/NCCPCfour.pdfhttp://www.ncpharmacists.org/associations/4188/files/NCCPCfour.pdf 4. Anaya JP, Rivera JO, et al. Evaluation of pharmacist-managed diabetes mellitus under a collaborative drug therapy agreement. American Journal Health-Systems Pharmacy [Internet]. 2008 October [cited 2012 November 6]; 65: 1841-1845. Available from: http://www.ncbi.nlm.nih.gov.libproxy2.usouthal.edu/pubmed/18796426http://www.ncbi.nlm.nih.gov.libproxy2.usouthal.edu/pubmed/18796426 5. Wubben DP, Vivian EM. Effects of Pharmacist Outpatient Interventions on Adults with Diabetes Mellitus: A Systematic Review. Pharmacotherapy [Internet]. 2008 November [cited 2012 November 6]; 28(4): 421-436. Available from: http://pharmacotherapyjournal.org.libproxy2.usouthal.edu/doi/pdf/10.1592/phco.28.4.421 http://pharmacotherapyjournal.org.libproxy2.usouthal.edu/doi/pdf/10.1592/phco.28.4.421 Disclosure Authors of this presentation have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation. Objectives Primary Objectives  Assess pharmacist impact through collaborative patient care on HbA1c values Secondary Objectives  Average blood pressure readings  Change in average lipids  Number of patients converted to insulin  Number of diabetes medications Baseline Characteristics VariableMeanSDMinMax Age59.7510.233672 Female0.530.5101 Non-White0.330.481501 # Comorbid Conditions5.081.8429 # Medications7.53.93218 HbA1C9.022.096.213.2 Scr1.160.870.474.8 TC20250112285 TG19812150507 HDL451524100 LDL1154345200 AST312513116 ALT33286116 Urine microalb/Cr ratio78.47172.71.9653.3 SBP13113106152 DBP809.46098 Interim Results VariableBaseline3 months6 months9 months12 months SBP131.13128.94129.14125.25134 DBP80.3677.3875.0776.2582.75 SCr1.161.0281.066*1.0640.946 Urine microalb/Scr73.63126.26N/A AST30.828.3327.730.425.13 ALT33.330.529.93328.5 * Indicates p < 0.05 * * Mean Lipid Values