Quality of care of a pharmacist-managed diabetes service compared to usual care in an indigent clinic

Background: This study evaluates the quality of care of a pharmacist-managed diabetes clinic focused on an indigent population and compares that quality of care to usual care in the same health care setting. Methods: Two groups of subjects were evaluated by retrospective review of medical records. The experimental group (n=47) consisted of patients whose care was facilitated by a clinical pharmacist (medication initiation and modification, laboratory and physical assessment) in addition to routine physician care. A control group (n=45) consisted of patients not referred to the pharmacy service whose care was provided solely by a physician. Changes in glycemic, blood pressure, and lipid control were assessed as were use of specific medications. Results: After an average of 1.8 years of follow-up, a larger reduction in hemoglobin A1C was observed in the experimental group (2.0%) compared to the control group (1.2%), but the difference was not statistically different. Both groups experienced significant improvements in blood pressure control with a higher absolute increase from baseline in the experimental group compared to the control group (34% vs. 22% respectively, P < 0.001). Low-density lipoprotein-cholesterol levels in the control group fell by 2 mg/dL, while a 29 mg/dL reduction was observed in the experimental group (P < 0.001). While aspirin, angiotensin-converting enzyme inhibitor, and angiotensin receptor blocker therapies were not different between the two groups, statin therapy was significantly improved in the experimental group (from 23% to 68%) compared to the control group (from 33% to 44%) (P=0.038). Conclusions: Many key diabetes quality of care outcomes in an indigent population were significantly improved in patients whose diabetes management was facilitated by a clinical pharmacist.