Clinical and economic impact of a diabetes clinical pharmacy service program in a university and primary care–based collaboration model

Objective To provide program methodology and outcomes data identifying the impact of clinical pharmacy services (CPSs) in patients with type 2 diabetes. Design Longitudinal pre–post cohort study. Setting Regional primary care group in Buffalo, NY, during 2006–2007. Patients Patients with type 2 diabetes identified by their primary care providers were referred to the MedSense program; a pharmacist-led, patient-centered pharmacotherapy management program developed through university collaboration with a regional primary care physician group. Interventions Education, clinical assessments, provider recommendations, and longitudinal follow-up of treatment goals provided by MedSense pharmacists. Main outcome measures Clinical outcomes were followed for 1 year from the index date for primary diabetes endpoints (glycosylated hemoglobin and fasting plasma glucose) and accompanying metabolic parameters (body mass index, blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides). Economic endpoints from the payer perspective were also followed for 1 year from the index date for medical and prescription-related costs. Results Primary diabetes endpoints were significantly reduced versus baseline at the 6-month (−1.1%; P P = 0.003) and 12-month (−1.1%; P P = 0.005) assessments. Improvement rates were observed for all accompanying metabolic parameters at each assessment (range 40–64%). Geometric mean costs tended to decrease versus baseline at 6-month (−$84; P = 0.785) and 12-month (−$216; P = 0.414) assessments, despite nominal increases in diabetes and total medication costs. Conclusion In this CPS model, there were initial and sustained reductions in the primary diabetes endpoints and a high rate of improvement for accompanying metabolic parameters. Concurrent with clinical improvements, total direct medical costs were reduced despite an increase in antidiabetic medication and total medication costs.