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    Spindler GLRC Presentation - Final

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    The study found that among 172 patients managed by pharmacists over 18 months, the average A1c level decreased by 2.01%. Secondary outcomes included an average increase in insulin doses among patients prescribed insulin and an average of 15 encounters between pharmacists and patients.

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    Spindler GLRC Presentation - Final

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    37 views27 pages
    The study found that among 172 patients managed by pharmacists over 18 months, the average A1c level decreased by 2.01%. Secondary outcomes included an average increase in insulin doses among patients prescribed insulin and an average of 15 encounters between pharmacists and patients.

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    spindler glrc presentation - final

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    The study found that among 172 patients managed by pharmacists over 18 months, the average A1c level decreased by 2.01%. Secondary outcomes included an average increase in insulin doses among patients prescribed insulin and an average of 15 encounters between pharmacists and patients.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    37 views27 pages

    Spindler GLRC Presentation - Final

    Uploaded by

    api-550398705
    The study found that among 172 patients managed by pharmacists over 18 months, the average A1c level decreased by 2.01%. Secondary outcomes included an average increase in insulin doses among patients prescribed insulin and an average of 15 encounters between pharmacists and patients.

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    You are on page 1of 27

    Pharmacist Impact on Patients’ A1c Levels While

    Practicing Under a Collaborative Practice


    Agreement

    Brittany Spindler, Pharm.D.


    PGY-1 Pharmacy Practice Resident
    Union Hospital

    Additional authors: Patrick Yoakum, Pharm.D., Meghan Williams, Pharm.D., BCPS,


    Beth Keys, Pharm.D., BCPS, Allison Veatch, Pharm.D.
    I HAVE NO ACTUAL OR POTENTIAL CONFLICT OF
    INTEREST IN RELATION TO THIS PRESENTATION

    2
    ABBREVIATION SLIDE
     CPA = Collaborative Practice Agreement
     CDTM = Collaborative Drug Therapy Management
     NGACO = Next Generation Accountable Care Organization
     PDP = Part D Plan
     DM = Diabetes Mellitus
     HTN = Hypertension
     HLD = Hyperlipidemia
     CHF = Chronic Heart Failure
     COPD = Chronic Obstructive Pulmonary Disease
     SGLT-2 = Sodium-glucose co-transporter-2 
     DPP-4 = Dipeptidyl peptidase-4
     GLP-1 = Glucagon-like peptide-1
     CGMs = Continuous glucose monitors
    3
    BACKGROUND

     Collaborative Practice Agreement (CPA)


     A formal agreement in which a licensed provider makes
    a diagnosis, supervises patient care, and refers patients
    to a pharmacist under a protocol that allows the
    pharmacist to perform specific patient care functions.
     The pharmacists included in this study practice under
    a collaborative practice agreement

    4
    UNION HOSPITAL CPA

     Consists of 7 different disease states


     DM, HTN, HLD, COPD, CHF, Tobacco Cessation,
    Asthma
     CDTM Protocols
     Eligible for patients > 18 years old
     All disease states associated with a CDTM protocol for
    pharmacists to manage medications and order
    appropriate labs
    5
    BACKGROUND
     Internal data for goal settings
     Potential Benefits
     Improved adherence
     Improved patient outcomes
     Reduced adverse events
     Hypoglycemic/hyperglycemic events, renal function, etc.

     De-escalating therapy or adding on medications when


    appropriate with more follow up opportunities
     Optimizes patient care with routine follow ups
    6
    INTERVENTIONS
     Optimize drug therapy
     Medication initiation, de-escalation, or dose
    adjustments
     Initiating continuous glucose monitors
     Increasing compliance and referrals
     Complete medication reconciliations
     Educating patients on medications and devices
     Cost inversions and insurance assistance 7
    SETTING
     Union Medical Group Primary Care
    Clinics
     Location
     Terre Haute, IN
     Rural area of western Indiana and
    eastern Illinois population
     16 clinics included in data
     31 providers

     Pharmacists:
     Started with 2 pharmacists
     Most data collected with approximately 3
    pharmacists
    8
    STUDY HYPOTHESIS
     With providing patients with multiple diabetic
    medication options (Metformin, SGLT-2 inhibitors,
    DPP-4 inhibitors, GLP-1 inhibitors, insulin, etc.), this
    has driven the need for patients to follow up with their
    provider more frequently to help prevent adverse drug
    reactions and increase adherence.
     This study sought to quantify the effectiveness of
    pharmacist’s interventions on decreasing patients A1c
    level.
    9
    PATIENT SPECIFIC FACTORS

    Demographic Average Range


    Age 67 35 – 90
    Baseline Weight (kg) 100.4 47.7 – 219.9
    Baseline Serum Creatine* 1.08 0.49 – 2.74
    (mg/dL)
    Baseline eGFR* (mL/min) 71.6 18 – 188
    * excluded dialysis patients (n = 2)

    10
    Insurance: payer breakdown
    5%

    17% Medicare PDP


    Medicaid
    Medicare +
    52%
    Medicaid
    19% Commercial
    None/unknown

    7%

    11
    METHODS
     Retrospective design study analyzing data from
    August 1st, 2019 to January 31st, 2021
     Inclusion criteria
     Patients managed by pharmacist under CPA
     Focus on Medicare NGACO patients
     Majority of patient referrals when A1c > 9%
     Only Type 2 DM patients included in this study, but
    pharmacists can be consulted for Type 1 DM
    12
    STUDY DESIGN
    Patients eligible for inclusion
    (n = 241)
    Excluded from the Study
    No repeat A1c level: 48
    Lost to follow-up: 13
    Referred to Endocrinology: 6
    Deceased: 2

    Patients included (n = 172)

    Collected Data (baseline


    values/medications versus current
    values/medications )
    13
    OUTCOMES

    Primary Outcome

    • Overall average change in A1c percentage in patients managed by


    pharmacists under CPA over 18 months

    Secondary Outcomes

    • Average change of insulin units per patient


    • Average change of diabetic medications per patient
    • Total number of encounters (phone call, in-person) with patient
    and pharmacist

    14
    RESULTS

    Primary outcome (n = 172)

    Average Change: A1c percentage decreased by 2.01%

    15
    AVERAGE CHANGE IN A1c - BREAKDOWN
    160

    140 145

    120 A1c Increased


    Number of Patients

    100 A1c Decreased

    80
    No Change
    60

    40

    20 23

    0 4

    16
    Range of A1c reduction: 0.1 – 9.4%
    POST-INTERVENTION A1c < 7%
    45

    40
    40

    35
    Pre-
    intervention
    Number of Patients

    30

    Post-
    25

    20

    15
    intervention
    10

    5
    5

    0 17
    POST-INTERVENTION A1c >9%

    140
    130

    120

    100
    Pre-intervention
    Number of Patients

    80
    Post-intervention
    60

    42
    40

    20

    18
    0
    SECONDARY OUTCOMES - INSULIN
     Number of patients on Insulin = 125 patients (~73%)
     Increased dose from baseline
     79 patients (~63%)
     Average per patient = 54 units (range: 2 – 660 units)
     Decreased dose from baseline
     29 patients (~23%)
     Average per patient = 54 units (range: 5 – 550 units)

    19
    SECONDARY OUTCOMES - MEDICATIONS

    n = 172
    Number of patients with medications added 51 (29.7%)
    Number of patients with medications discontinued 23 (13.4%)
    Number of patients with medication dose adjustments 172 (100%)

    20
    MEDICATION FORMULATIONS

    Oral + Non-insulin
    Injection + Insulin
    13% Oral
    18%
    Non-insulin
    Injection + Insulin Non-insulin
    7% Injection
    1%

    Oral + Non-insulin
    Injection
    8%

    Oral + Insulin
    26%

    Insulin
    27% 21
    SECONDARY OUTCOME - ENCOUNTERS

     Encounters were accounted for when pharmacist met with


    patient via phone call or in-person to adjust medications and
    discuss compliance

    Number of Encounters Range of Encounters Average Encounters


    2600 2 – 55 15.2

     Duration of direct patient care with pharmacist


     Average: ~6.7 months
     Range: 31 – 527 days 22
    LIMITATIONS
     Lost patients to follow up
     Covid-19 pandemic
     Difficult to reach patient in certain circumstances
     No additional comorbidity data included
     Endocrine referrals
     Retrospective study with no control group for comparison
     Duration of data
     Different clinics/physicians
     Physician engagement varies from clinic to clinic 23
    DISCUSSION
     Pharmacist interventions have a large impact on
    diabetic patient care
     Collaborative practice agreements are necessary for
    pharmacists to work independently and efficiently in
    order to have successful patient outcomes.
     Expansion of population health pharmacist
     Adding 2 more population health pharmacists this
    summer
    24
    DISCUSSION

     Future studies
    1. Compare data to a control group
    2. With future expansion in population health, can
    expand studies to other disease states included in
    current CPA
    3. Focus on other pharmacist assistance (i.e. insurance
    assistance, cost of medications, CGMs)

    25
    SELF-ASSESSMENT QUESTION

     According to the ADA Guidelines, what is the goal A1c


    % in patients with diabetes?
    a) <6%
    b) <7%
    c) <8%
    d) <10%

    26
    SELF-ASSESSMENT QUESTION

     Which of the following are opportunities for


    pharmacist interventions throughout a collaborative
    practice agreement?
    a) Patient education and counseling
    b) Medication reconciliation
    c) Medication accessibility
    d) All of the above

    27

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