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JAIME P. ANAYA, B.S., PHARM.D., is Clinical Assistant Professor of Pharmacy and Director, Community Pharmacy Residency Program, University of Texas El Paso (UTEP)/University of Texas (UT) Austin Cooperative Pharmacy Program, El Paso. JOSE O. RIVERA, PHARM.D., is Director and Clinical Associate Professor, UTEP/UT Austin Cooperative Pharmacy Program. KEN LAWSON, PH.D., is Associate Professor, College of Pharmacy, UT Austin, Austin. JOSE GARCIA, B.S., is Clinical Pharmacist; and JOSE LUNA JR., M.D., M.B.A., is Medical Director, Centro Van Vicente, El Paso. MELCHOR ORTIZ, PH.D., is Professor of Biostatistics, School of Public Health, UT Houston, El Paso.

Address correspondence to Dr. Anaya at the University of Texas El Paso/Austin Pharmacy, 1100 North Stanton, Suite 301, El Paso, TX 79902 (janaya{at}utep.edu).

Purpose. The effect of a pharmacist-managed collaborative drug therapy agreement (CDTA) on diabetes mellitus (DM) management in an outpatient setting is evaluated. Methods. Patients with DM were referred by physicians to the pharmacist for either education or clinical management of DM under the CDTA. A retrospective chart review was conducted between September 2001 and December 2005 and included patients who had laboratory values of interest within one year before and after the initial visit and who had more than two documented visits with the pharmacist. After the pharmacist’s intervention in the DM management, glycosylated hemoglobin (HbA1c) and low-density lipoprotein cholesterol were compared using a paired sample t test. Average costs for inpatient hospitalization and emergency department (ED) admission were also compared. Results. A total of 110 patients had a mean ± S.D. of 5.7 ± 3.9 visits with the pharmacist. A mean reduction in HbA1c of 0.7% (p 0.001, n = 93) from 8.9% to 8.2% and a mean reduction in blood glucose of 26.4 mg/dL (p 0.001, n = 99) were achieved. Average costs for inpatient hospitalization and ED admissions were significantly higher in the preintervention period than in the postintervention period for patients with DM as the primary or secondary diagnosis ($2434 versus $636, respectively; p = 0.015). For patients with a primary diagnosis of diabetes, preintervention costs were higher than postintervention costs, but this difference was not significant ($3082 versus $696, respectively; p = 0.100). Conclusion. Pharmacist interventions under a CDTA resulted in significant improvements in glucose and HbA1c levels in patients with DM. Postintervention costs for inpatient hospitalization and ED services were significantly less than preintervention costs when DM was a primary or secondary diagnosis for the admission. Index terms: Ambulatory care; Diabetes mellitus; Economics; Interventions; Pharmaceutical services; Pharmacists