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NANCY T. NKANSAH, PHARM.D., BCPS, is Assistant Professor of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco (UCSF), and Clinical Pharmacy Specialist, UCSF Fresno Pharmacy Education Program, Fresno; at the time of this study she was Pharmacy Practice Resident and Primary Care Resident, Johns Hopkins Hospital (JHH), Baltimore, MD. JEFFREY M. BREWER, PHARM.D., BCPS, is Clinical Pharmacy Specialist, JHH, and Primary Care Program Director, Johns Hopkins Community Physicians (JHCP) at Wyman Park, Baltimore. ROBERT CONNORS, M.D., is Internist and Office Medical Director, JHCP at Wyman Park. KENNETHM. SHERMOCK, PHARM.D., is Director, Center of Pharmaceutical Outcomes, JHH.

Address correspondence to Dr. Nkansah at the University of California, San Francisco, Fresno Pharmacy Education Program, 155 North Fresno Street, Suite 251, Fresno, CA 93701 (nkansahn{at}pharmacy.ucsf.edu).

Purpose. The clinical outcomes of patients with diabetes mellitus in an urban environment receiving pharmacist medication management in collaboration with private-practice physicians were assessed. Methods. Patients older than 18 years with type 1 or 2 diabetes mellitus who were receiving oral and insulin therapy and who were referred to a pharmacy clinic within a private physician practice for medication management between March 1, 2002, and August 31, 2003, were eligible for study inclusion. Data were collected at three junctures: six months before the first visit with the pharmacist (preperiod measure), on the date of clinic entry (index measure), and six months after the first clinic visit (postperiod measure). Primary outcomes analyzed were glycosylated hemoglobin (HbA1c), weight, and blood pressure (goal, <130/80 mm Hg). Secondary outcomes analyzed were smoking cessation and initiation of aspirin, angiotensin-converting-enzyme inhibitor, or angiotensin receptor blocker therapy. Results. A significant reduction in HbA1c from the index measure to the postperiod measure was observed (p < 0.001). No significant change was noted in weight or number of patients at goal blood pressure among the preperiod, index, and postperiod measures. No change was observed in the secondary outcomes during the study time intervals. Conclusion. Integrating a pharmacist into a private physician practice significantly improved patient glycemic control and maintained patients’ weight and the number of patients at blood pressure goal. Clinic adherence with the American Diabetes Association recommendations was sustained. Index terms: Ambulatory care; American Diabetes Association; Clinical pharmacists; Diabetes mellitus; Outcomes; Pharmaceutical services; Primary care; Protocols; Team

 

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