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DIABETES

Caring for Poorly Controlled Diabetes Mellitus: A Randomized Pharmacist Intervention

Senior Lecturer, School of Pharmacy, University of Washington; Clinical Specialist and Diabetes Educator, Evergreen Community Health Care, Seattle, WA

Alvin Goo, PharmD CDE BCPS

Clinical Pharmacist, Harborview Medical Center; Clinical Instructor, Departments of Pharmacy and Family Medicine, University of Washington

Jeff Hummel, MD MPH

Director of Research, University of Washington Physicians Network; Clinical Associate Professor, School of Medicine, University of Washington

Kristal L Williams, PharmD

Assistant Professor of Pharmacy Practice, College of Pharmacy & Health Sciences, Butler University; Clinical Pharmacist, Clarian Health Systems and Indiana University— Methodist Family Practice Residency

Shelly L Gray, PharmD MS BCPS

Associate Professor, School of Pharmacy, University of Washington; Director, Geriatrics Program, School of Pharmacy, University of Washington

Reprints: Dr. Odegard, School of Pharmacy, University of Washington, Box 357630, 1959 NE Pacific St., Seattle, WA 98195-7630, fax 206/543-3835, podegard{at}u.washington.edu

BACKGROUND: There is limited information from randomized controlled studies about the influence of pharmacist interventions on diabetes control.

OBJECTIVE: To evaluate the effect of a pharmacist intervention on improving diabetes control; secondary endpoints were medication appropriateness and self-reported adherence.

METHODS: A randomized, controlled, multi-clinic trial was conducted in the University of Washington Medicine Neighborhood Clinics. Seventy-seven subjects, 18 years old with a hemoglobin (Hb) A_1c 9% at baseline and taking at least one oral diabetes medication, were randomized to receive a pharmacist intervention (n = 43) or usual care (n = 34) for 6 months followed by a 6-month usual-care observation period for both groups. Subjects met with a clinical pharmacist to establish and initiate a diabetes care plan followed by weekly visits or telephone calls to facilitate diabetes management and adherence. HbA_1c, medication appropriateness, and self-reported adherence were assessed at baseline, 6 months, and 12 months.

RESULTS: The mean HbA_1c did not differ between groups over the 12-month period (p = 0.61). A reduction in HbA_1c was noted for both groups over time compared with baseline (p = 0.001); however, control subjects relied more heavily on provider visits. Medication appropriateness was not improved for diabetes medications (p = 0.65). Self-reported adherence was not significantly improved by the intervention.

CONCLUSIONS: This pharmacist intervention did not significantly improve diabetes control, but did allow for similar HbA_1c control with fewer physician visits. Medication appropriateness and self-reported adherence compared with usual care in individuals with poorly controlled diabetes were not changed.

Key Words: diabetes, medication appropriateness, pharmacist intervention

Published Online, February 8, 2005. www.theannals.com, DOI 10.1345/aph.1E438

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