Pharmacist-Led Interventions Can Improve HbA1c in Underserved Communities

Kimberly Narain, MD, PhD, MPH
Credit: X.com

Greater incorporation of pharmacists into the care of people with type 2 diabetes could improve disease management for underserved populations, according to the results of a new study.

A quality improvement study leveraging EHR data and a difference-in-difference study design, results suggest use a pharmacist-led intervention focused on improving medication adherence and guideline-concordant care was associated with improvements in HbA1c and blood pressure among Hispanic adults with type 2 diabetes.¹

“These findings suggest that collaborations between physicians and pharmacists might lead to better diabetes outcomes for some patients, compared to only receiving the usual standard of care from just a primary care physician,” said lead investigator Kimberly Narain, MD, PhD, MPH, assistant professor-in-residence of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).²

Together with colleagues from UCLA, Narain and a team of investigators sought to examine to what extent a pharmacist-led intervention could improve management outcomes in type 2 diabetes relative to usual care. Funded by the National Institute on Aging and the National Institute of Diabetes and Digestive and Kidney Diseases, the current study used a difference-in-differences study design to determine the effect of UCMyRx exposure on changes in HbA1c and systolic blood pressure among Hispanic patients with diabetes.¹

The UCMyRx was launched at UCLA in 2012 and exists in 38 primary care clinics. According to investigators, the initiative involves clinical pharmacists trained in motivational interviewing into primary care practices to comanage patients with complex care needs along with their primary care physicians. Patients participating in the program can access the program in multiple ways, including their primary care physician, clinical care coordinator, or self-referral.¹

As part of the initiative’s design, during the first visit, invitees will have a clinical pharmacist review vital signs and laboratory results, order laboratory tests as needed, perform medication reconciliation, assess medication adherence using a standardized survey, and, based on the results of the survey, implement a personally tailored intervention to improve medication adherence.¹

The primary outcomes of interest were changes in the pre- to post-index date changes in HbA1c and systolic blood pressure. For the purpose of analysis, investigators planned additional comparisons using propensity score-matched cohorts of those who received the UCMyRx intervention and those receiving usual care. People with diabetes are invited from the UCLA Diabetes Registry to participate if they have an HbA1c of 9% or greater, systolic blood pressure of 140 mmHg or greater, LDL-C of 130 mg/dL or greater, or having received 5 or more prescription medications.¹

For inclusion in the current study, patients needed to be aged 18 years or older, with 1 or more visits with a UCMyRx pharmacist or 2 or more visits, 2 or more years apart, during the study window, which was defined as March 2, 2013-December 31, 2018. Additional inclusion analysis required patients to have an HbA1c of 8% or greater anywhere between 365 days before and 14 days after the index date and a follow-up HbA1c measure within 120 to 365 days after the index date and/or a systolic blood pressure of 140 mmHg or higher between 365 days before and 14 days after the index date, and a follow-up SBP measure within 120 to 450 days after the index date.¹

In total, 931 patients with type 2 diabetes were identified for inclusion. This cohort had a mean age of 64 (Standard deviation [SD], 14.1) years, 59.3% were female, and 49.7% had an English language preference. Investigators pointed out the postmatching sample sizes for the main HbA1c and blood pressure outcomes were 396 and 795, respectively.¹

In adjusted analyses, results suggested having at least 1 UCMyRx visit was associated with a reduction in HbA1c concentration (β = −0.46%; 95% Confidence Interval [CI], −0.84% to −0.07%; P = .02), but investigators pointed out there was no significant change in systolic blood pressure (β = −1.71 mm Hg; 95% CI, −4.01 to 0.58 mmHg; P = .14).¹

“They demonstrate the potential of collaborative care such as this to improve diabetes outcomes, relative to care received from a physician alone, irrespective of ethnicity,” Narain added.² “The magnitude of the difference is consistent with what might be achieved by adding another medication for diabetes. The benefits were observable even after a single visit with a pharmacist.”

References:

1. Narain KDC, Moreno G, Bell DS, et al. Pharmacist-Led Diabetes Control Intervention and Health Outcomes in Hispanic Patients With Diabetes. JAMA Netw Open. 2023;6(9):e2335409. doi:10.1001/jamanetworkopen.2023.35409
2. Rivero E. Pharmacist-led intervention can improve medication adherence among Latinos with type 2 diabetes. UCLA Health System. September 28, 2023. Accessed September 28, 2023. https://www.uclahealth.org/news/pharmacist-led-intervention-can-improve-medication-adherence.