Clinical Outcomes Associated With a Collaborative Pharmacist-Endocrinologist Diabetes Intense Medical Management “Tune Up” Clinic in Complex Patients

Abstract

Background: No previous studies exist examining the impact of a short-term pharmacist-endocrinologist collaborative practice model on glycemic control in complex patients. Objective: Evaluate outcomes associated with a PharmD-Endocrinologist Diabetes Intense Medical Management (DIMM) “tune up” clinic for complex patients. Methods: A retrospective cohort study of 99 patients referred to DIMM clinic versus a comparator group of 56 primary care provider (PCP) patients meeting the same criteria (adult type 2 diabetes patients, glycosylated hemoglobin [A1C] ≥ 8%, follow-up visit within 6 months) in a Veterans Affairs Medical Center. DIMM clinic used a short-term model that coupled personalized clinical care with real-time, patient-specific diabetes education during two to four 60-minute visits over 6 months. PCP patients received usual care. Primary outcome was mean A1C change after 6 months. Secondary measures included fasting blood glucose, lipids, blood pressure, weight, body mass index, and percentage of patients meeting goals. Results: Patients in each group had an average of 8 and were taking 12 to 14 medications daily. Mean A1C (%) improvement in DIMM group was significantly greater at 6 months (−2.4 [SD = 2.1] vs −0.8 [SD = 1.7]; P < 0.001), than PCP group. Percentage meeting A1C goal levels (<7%, <8%, and <9%) was significantly greater at 3 and 6 months compared with baseline in the DIMM group ( P < 0.001) versus (only <8%) at 3 and 6 months compared with baseline in PCP group. Conclusions: The DIMM clinic “tune up” model demonstrates a successful collaborative practice which helped complex diabetes patients achieve glycemic control in a 6-month period.