May 11, 2018
For veterans with type 2 diabetes, integration of clinical pharmacists was associated with reduced A1c levels from baseline compared with modeled usual care, according to the results of a recent study in the Journal of Managed Care & Specialty Pharmacy.
The study measured the effectiveness of a data collection tool for clinical pharmacists working in advanced practice provider roles within the Department of Veterans Affairs. The tool is used to document interventions and associated clinical outcomes.
For their current study, the team of researchers, led by Heather Ourth, PharmD, predicted the long-term effect of clinical pharmacist-provided pharmacotherapy management on outcomes and costs for patients in the VA with type 2 diabetes. To achieve this, they used baseline patient demographics and biomarkers for 7310 type 2 diabetic patients who had more than one encounter with a clinical pharmacist between January 5, 2013, and November 20, 2014. Further, the researchers used treatment biomarker values 12 months after the patient’s initial visit with the clinical pharmacists. Simulation modeling was also performed on 3 patient cohorts which focused on those with a baseline hemoglobin A1c of 8% to < 9%, 9% to < 10%, and ≥ 10%—this estimated long-term cost and clinical outcomes using modeling based on pivotal trial data.
According to the study findings, the analysis of costs and events on 2-, 3-, 5-, and 10-year time horizons demonstrated significant reductions in major adverse cardiovascular events (MACEs), myocardial infarctions (MIs), episodes of acute heart failure, foot ulcers, and foot amputations in comparison with a control group receiving usual guideline-directed medical care. Additionally, in the cohort of patients with a baseline A1c of ≥ 10%, the researchers observed an absolute risk reduction of 1.82% for MACE, 1.73% for MI, 2.43% for acute heart failure, 5.38% for foot ulcers, and 2.03% for foot amputations.
Additionally, the incremental cost-effectiveness ratios for cost per quality-adjusted life-year during the multiple time horizons were cost-effective for the cohorts of patients with a baseline A1c of 9% to < 10% and ≥ 10%.
“Clinical pharmacists acting as advanced practice providers reduced A1c from baseline for veterans with type 2 diabetes compared with modeled usual care,” the researchers concluded. “Archimedes modeling of the A1c reductions projects a decreased incidence of diabetes complications and overall health care spending when compared with modeled usual care.”
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