The Effect of Clinical Pharmacist-Led Comprehensive Medication Management on Chronic Disease State Goal Attainment in a Patient-Centered Medical Home

BACKGROUND: Clinical pharmacy services were initiated at 7 of 11 clinics within a primary care network (PCN), which was designated as a patient-centered medical home and was affiliated with a large academic medical center in October 2014. The goal of the service was to target patients with uncontrolled chronic conditions, specifically diabetes. Patients met with a clinical pharmacist through individual clinic and telephonic appointments, in addition to usual appointments with physicians as needed. While managing patients with diabetes, many clinicians assess a patient’s hemoglobin A1c (A1c), along with blood pressure and cholesterol, as indicators of disease state control and cardiovascular risk. These 3 parameters were combined into a bundled response score (BRS) in order to assess whether the addition of the clinical pharmacy service had a positive effect on patient therapeutic goal attainment rates for these areas. OBJECTIVES: To assess the effect of pharmacist-led comprehensive medication management (CMM) on therapeutic goal attainment rates for glycemic, blood pressure, and dyslipidemia outcomes in PCN patients, which was represented by a BRS based on how many therapeutic goals were met. METHODS: This retrospective study was conducted using patients seen in clinics within the PCN between October 1, 2014, and October 31, 2015. Patients were included in the intervention group if they were actively managed by a PCN pharmacist and had a diagnosis of diabetes. A control group included patients without access to a PCN pharmacist and was matched to the intervention group by baseline A1c results. Based on current clinical practice guidelines, therapeutic goals for the BRS were set as A1c ≤ 8%, blood pressure ≤ 140/90 mmHg, and prescription of a moderate- to high-intensity statin for dyslipidemia. In addition to the primary outcome, the individual components of the BRS were assessed, as well as the average number of medications used between groups. RESULTS: There were 95 patients included in the intervention group, with 132 patients included in the usual care group. Patients in the intervention group had significantly higher rates of therapeutic goal attainment for the 3 endpoints (40% vs. 12%, P < 0.001). The intervention group had statistically significantly higher improvements in the individual areas of A1c, blood pressure, and statin goal attainment. There were no significant differences in the number of medications for diabetes or antihypertensive medications used between groups at the time of study termination. CONCLUSIONS: This study demonstrated that the addition of CMM services provided by clinical pharmacists in this PCN had a positive effect on therapeutic goal attainment rates for patients with diabetes. This finding suggests that the integration of clinical pharmacists into primary care clinics could have positive effects on the clinical outcomes of diabetic patients in glycemic control, blood pressure, and statin treatment, in accordance with current guidelines.