Pharmacy Based Diabetes Management Service

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Pharmacy Based Diabetes Management Service

• Sandra Leal, Pharm.D. CDE
• Clinical Pharmacy Supervisor

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Objectives

• Describe the rationale for initiation of El Rios
  Pharmacy Based Diabetes Management Service
• Explain El Rios program outcomes
• Identify tools that have made the program
  successful

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El Rios Main Downtown Clinic
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Services Offered at El Rio

• Homeless Medical Outreach
• Lab/X-Ray/Diagnostics
• Gynecology/Deliveries
• Optical
• School-Based Pediatric Clinics

• Primary Care
• Case Management
• Onsite Pharmacy
• (3 sites)
• Behavioral Health
• Dental
• HIV/AIDS

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Demographics by Culture/Race
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Increasing Patient Access and Improving Outcomes
in Diabetic Patient Through Pharmacy-Based
Disease Management Services
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El Rios Pharmacy Demonstration Project

• In August 2001
• El Rio Clinic provided a pharmacist managed
  diabetes (DM) clinic
• Comprehensive Pharmacy Services Grants awarded by
  the Office of Pharmacy Affairs (OPA) a component
  of the Health Resources and Services
  Administration Healthcare Systems Bureau (HRSA)

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El Rios Pharmacy Demonstration Project

• OPA emphasizes
• Importance of comprehensive pharmacy services
  being an integral part of primary health care
• Comprehensive pharmacy services include
• Patient access to affordable pharmaceuticals
• Application of "best practices" and efficient
  pharmacy management
• Application of systems that improve patient
  outcomes through safe and effective medication
  use

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At the Same Time

• Opportunities opened with Arizona Bill 2415
• Pharmacists prescriptive authority
• Collaborative agreements with providers and
  patients created

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Why a Diabetes Clinic?

• Major cause of morbidity and mortality
• Cost 132 billion dollars in 2002
• Opportunities to improve care
• Quality measures (HEDIS)
• Lipid management
• Blood pressure management

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Objectives/Method

• To evaluate changes in clinical parameters and
  medication use
• Improve comprehensive access to diabetes care
• Access ? database created in 02/02 for patient
  trackingpivotal to success of program

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Access? Database

• Data collected
• Demographics
• Medical history
• Medications
• Labs
• Vitals
• Preventative Services
• SOAP notes to print for chart

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Typical Visit

• Day before appointment-thorough review of chart
  for baseline
• Foot exam/monofilament test
• Review of diabetes, blood pressure, lipids
  including goals and previous lab work
• Initiate self-testing
• Ophthalmology referral
• Smoking cessation counseling
• Aspirin
• Depression Screening
• Update vaccinations

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Results
Changes in Recommended Annual Follow-up
Screenings
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Results
Changes in Metabolic and BP Measures Baseline to
Follow-up
Percents rounded to nearest whole number except
for A1C, HDLc and Body Mass Index (BMI)
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Significance
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Significance
N3017 adults with diabetes in a large
HMO Standardized 3-year charges from 1993 - 1995
Cost were found to be higher if the person also
had heart disease and high blood pressure.
Gilmer TP. OConnor PJ, Manning WG, Rush WA. The
cost to health plans of poor glycemic
control. Diabetes Care 201847-1853, 1997.
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Economic Impact of Poor Glycemic Control
56
48
Diabetes alone
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Diabetes, hypertension, and heart disease
3-yr Medical Costs (Thousands)
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8
0
6
7
8
9
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Baseline A1C ()
Adapted with permission from Gilmer T et al.
Diabetes Care. 1997201847
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Results
Changes from Baseline to Follow-Up for Patients
on ASA and ACEIs/ARBs
45 patients with ASA contraindication 35
patients had contraindication to ACEI/ARB
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Outcomes

• Pascua Yaqui pharmacist added
• Pharmacy practice resident added
• Improved quality of life for patients as
  documented by measurable parameters and
  self-report
• Several Publications Including

Leal S. Medications, rationing, and health care
the role of pharmacists in bridging the gap.
J Health Care Poor Underserved. 2005
Aug16(3)418-20. Leal S, Soto M. Pharmacists
disease state management through a collaborative
practice model. J Health Care Poor
Underserved. 2005 May16(2)220-4. Leal S, Glover
JJ, Herrier RN, Felix A. Improving quality of
care in diabetes through a comprehensive
pharmacist-based disease management
program. Diabetes Care. 2004
Dec27(12)2983-4.
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Contact Information

• Sandra Leal, Pharm.D., CDE
• Clinical Pharmacy Supervisor
• El Rio Health Center
• 839 W. Congress
• Tucson, Arizona 85745
• Office 520-670-3805
• Email SandraL_at_elrio.org